but we need your help
Referrals are welcomed from individuals, family members and health professionals.
Complete the online referral form and a member of our Customer Service team will be in touch to discuss things further.
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Title Please SelectMrMsMrsMissDr
First name *
Last name *
Is an Interpreter required? * Please SelectYesNo
If Yes, please state the Language
Mobile or Landline * Format: AreaCode + No.
Is this a self-referral? Please SelectYesNo
State Please SelectAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoria Western Australia
Last name *
Your relationship to person you are referring *
Do you have consent to make this referral? * Please SelectYesNo
Where did you hear about us? Please SelectAged CareAgencyExpo / ShowExternal GD AgencyFamily Member/CareerFunding AgencyGDV Direct MailGuide Dog TeamHealth ProfessionalHerald SunLocal PressMagazineOtherOther GD AgencyPuppy RaiserPup WalkingRadioSchool/DETService ProviderShopping CentreTelevisionVisiting TeacherWeb Site
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
Medical Action Plans
Other Medical information
Does the client receive any funding from any of the following: * Please SelectBetter StartMy Aged CareNDISTACVeterans AffairsWorkcoverOtherNot Applicable
If yes, what is their provider number?
Title * MrMrsMissMsDr
First Name *
Last Name *
Email address *
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2-4 Thomas Street, Chatswood NSW 2067
02 9412 9300