Make a referral

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Sponsor

Sponsor a Puppy

your monthly support will help more puppies get a head start on becoming Guide Dogs

Learn more

Have you seen our TV ad?

sponsor a puppy today

Learn more

Complete the online referral form and a member of our Customer Service team will be in touch to discuss things further.

Fields marked with * are required.

Client Details

Title

First name *

Last name *

Birthdate *

Is an Interpreter required? *

If Yes, please state the Language

Mobile or Landline *

Format: AreaCode + No.

Is this a self-referral?

Address

Street

Suburb/Town

State

Postcode

Country

Referrer Details

First name *

Last name *

Your relationship to person you are referring *

Mobile or Landline *

Format: AreaCode + No.

Email *

Do you have consent to make this referral? *

Referral Information

Where did you hear about us?

Please provide information about their vision *

32768 characters remaining

What support would they like from Guide Dogs NSW / ACT? *

32768 characters remaining

Please upload relevant documents
Vision report

Discharge Summary

Medical Action Plans

Other Medical information

Does the client receive any funding from any of the following: *

If yes, what is their provider number?

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Our Services

Get Involved

Our Dogs

Resources

Sponsor a Puppy

Have you seen our TV ad?

Client Details

Address

Referrer Details

Referral Information

Sponsor a Puppy

Have you seen our TV ad?

Sponsor a Puppy

Have you seen our TV ad?

Client Details

Address

Referrer Details

Referral Information

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Guide Dogs NSW / ACT