Unfortunately, ACT Group is currently unable to accept new private counselling referrals.
To find out more please follow this link.

Referral Form

Please enter your referral below. To ensure all information is captured correctly, please follow these instructions:

  1. Complete the fields on screen and select NEXT
  2. Wait for the detailed referral form to load (some browsers will require you to open the form in a new tab – if so, the form will present you a link to click)
  3. The form will time out if left unattended so please gather information beforehand
  4. Once all the referral information is entered, click SUBMIT

If you have any issues, please call 1300 034 503 or email

Once your referral has been submitted, an intake clinician will be in touch within 2 – 3 business days.

Intake days: Tuesday, Wednesday and Thursday morning

Please note this form is completed in two parts. A second page will load once you click next.