Thank you for referring to headspace Box Hill.  

This form is for young people aged 12-25 to self refer to this service. If you are a family member, friend or a professional wanting to refer someone else to headspace Box Hill please use our other forms or call our friendly team on 9810 9310. 

headspace Box Hill is managed by Mind Australia as the lead agency. Your referral will be viewed by the Intake and Assessment team to  determine which supports will best meet your needs . All your information is private and confidential, and all information you submit on this form, is stored on a secure server.  

This form will take approximately 10 minutes to complete.

Before proceeding with this self referral form please ensure you have read and understood the "What you need to know" document. 

We are not a crisis service. If you are concerned for your or someone else's safety, please contact 000 immediately or call your local Mental Health Triage Service.

Eastern Mental Health Triage 1300 721 927 (Maroondah, Knox, Yarra Ranges, Manningham, Whitehorse and Monash)

St Vincent’s Mental Health Triage 1300 558 862 (Yarra & Boroondara)

Lifeline (24/7): 13 11 14 or webchat/text at lifeline.org.au

Beyondblue (24/7): 1300 224 636 or webchat at beyondblue.org.au

Suicide Call Back Service (24/7): 1300 659 467 or webchat at suicidecallbackservice.org.au

To process this referral and determine which supports will best meet your needs, headspace Box Hill will need to collect some information about you. This information will be accessible to the headspace Intake and Assessment team working on your referral. 

We will securely record any information you provide, and it will only be shared where we are required to by law or with your permission.

Please read the Mind Australia  "What you need to know" document before going any further. 

The information in this section is required to process this referral. 

If you prefer you can call the centre on 9810 9310 to make a referral over the phone. 

This information is not required however it helps us to determine your support needs

Once you submit this form, you consent to headspace Box Hill contacting you on the details provided.         

The Intake & Assessment team will make every effort to contact you within 3 business days. 

headspace Box Hill is not a crisis service if you are experiencing a mental health crisis please contact emergency services via 000 or one of the below acute mental health services:  

Eastern Mental Health Triage 1300 721 927 (Maroondah, Knox, Yarra Ranges, Manningham, Whitehorse and Monash)

St Vincent’s Mental Health Triage 1300 558 862 (Yarra & Boroondara)

Lifeline (24/7): 13 11 14 or webchat/text at lifeline.org.au

Beyondblue (24/7): 1300 224 636 or webchat at beyondblue.org.au

Suicide Call Back Service (24/7): 1300 659 467 or webchat at suicidecallbackservice.org.au