Refer Someone To Us

Referral / Service Enquiry

Please use this form to enquire about Communify services for yourself or for someone you know.

Alternatively you can download the form here and email it to

We will get back to you via phone or e mail as soon as possible.

Alternatively, you can ask about our services by calling us on 3510 2700.

Many of our services are ‘full’ or have waiting lists. There will also be limits on the geographical areas we can provide services too.  Please be aware that completing this enquiry form will not automatically guarantee service or a place on our wait list. It is important that you talk to us about whether we will be able to provide a service for the person you are referring.

For referral to Partners in Recovery do not use this form.Please call North Brisbane Partners in Recovery on 1800 752 235

Person requesting service
Your Name

Your Address

Your Email

Your Phone

Date of Birth

I would prefer to be contacted by
phoneemail

Details of the person you're referring
YourselfSomeone Else
Name

Your relationship to this person

Address

Email

Phone

Services you require or are interested in

In home support services:
Domestic assistanceHome assist secureAllied health
Personal careIn-home nursingMeals on Wheels

Aged services (over 65):
Day respiteSocial support

Mental health services:
Personal Helpers and Mentors (PHaMs)Mental Health and Disability Support (under 65)
Partners in Recovery (PIR)

Family and Individual Support Services:
Emergency Assistance (The Pantry)No Interest Loan Scheme (NILS)Community transport

Other assistance needed (please detail):

Summary of current situation:

Any services currently received:

Anything else we might need to know:

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Privacy

The Information Privacy Act 2000 was introduced to protect the privacy of your personal information. Communify respects your privacy and must comply with this legislation when it comes to the way in which we collect, use, disclose, access, transmit and dispose of any personal and health information we hold about you.

We take our privacy responsibilities seriously and we aim to ensure our practices fully comply with relevant legislation.

We collect data about the use of our website. This information helps us to know what is useful on our website and what might need improving.

If you give us your email address we promise to look after it and while we might send you updates from Communify, we won’t pass it on to any other organizations without your permission.

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