Counselling Referral

This form may not be continuously monitored. If the matter is of an *urgent psychological nature* please call 000, or go directly to the Emergency Department at the local District Hospital.

If the matter requires immediate support please contact:

>            Kids Helpline (24 hours, free call)                    1800 55 1800

>            Lifeline (24/7)                                                    13 11 14

>            eheadspace (9am - 1am)                                  1800 650 890

>            Headspace Townsville  (8.30am - 4.30pm)   4799 1799

>            Alternatively, online counselling and support is available via www.eheadspace.org.au or www.lifeline.org.au

Counselling Referral

Name of Person Making Referral

Relationship of Person Making Referral

Students Name

Year Level

Date of Referral

Email

Issues of Concern

If 'Other' please specify here

Brief Outline of the Concern - Including any safety issue

Have you spoken to Year level Coordinators about this student? *
Yes
No

Priority of the referral

Details (please include date)

Contact

Contact Details

office@columba.catholic.edu.au

PO Box 274
Charters Towers QLD 4820

Campus

Mt Carmel Campus

Phone: 07 4787 1744
Fax: 07 4787 4986
6-8 Hackett Terrace
Charters Towers QLD 4820

St Mary's Campus

Phone: 07 4754 6333
59-69 Mary Street
Charters Towers QLD 4820

22 May

We are in week 5 of Term 2
There are 10 weeks in Term 2

The Roman Catholic Trust Corporation for the Diocese of Townsville |
CRICOS Provider Code 01824G