Whether you're living with HIV, supporting someone who is, or making a professional referral, our team can support connect you with information, services and peer support. Complete the form below and a Positive Life NSW staff member will be in touch.

Who is this referral for? *
Please select one option:

fields marked with * are mandatory

Referrer's Contact Details

Has the client consented to this referral? *

Positive Life NSW may be limited in the support we can provide without community member's consent.

Your Details

Is the person aware and agreed to this referral? *

Positive Life NSW requires the person's consent before providing support services.

Your details

Person requiring support details

Community member details

Preferred Pronouns
Gender:
Sexual Orientation
Do you identify as Aboriginal or Torres Strait Islander
Do they identify as Aboriginal or Torres Strait Islander
Are you living with HIV?
Are they living with HIV?
Interpreter Required?
Australian Resident

Your Contact

Person requiring support details

Community member contact details

Preferred Contact
Mailing Address

Reasons for contacting Positive Life NSW

Support requested. Tick all that apply.

Additional information
Please provide any information that may help us understand the support needs

Consent for Referral

I acknowledge that my typed name below can be used as a digital representation of my signature to that fact. To accept, type your name below and click the submit button.

 

Important information regarding this Positive Life NSW Referral and Intake Process

If at any point during the referral and intake process the individual wishes to withdraw their consent, they are at liberty to do so.

If the individual or referrer wants to discuss any matters relating to this referral or the intake process, contact Positive Life NSW on (02) 8357 8386 or by email to contact@positivelife.org.au

 

Aboriginal and Torres Strait Islander Support
housing support for people living with HIV
Ageing Support
Treatments and Managing your HIV