Refer Someone

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REFER Someone to MATES

You Are Not Alone - MATES Cafe Worldwide
MATES Cafe is a network of everyday people of all ages, cultures and ethnicity (including teens, elders and lgbt+)
who are trained to meet with a person in crisis or isolation at a local cafe, and provide emotional support and encouragement.

Refer Someone to MATES

We appreciate your referrals. Information collected from this referral form and associated means will be held in strictest confidentiality by the MATES Organisation. This information will only be used to help in understanding what course of action might be best for the person referred and for MATES records/information only.

MATES Referral Form

* Indicates required field

Referral for (Client): *

First

Last

(Client) Email: *

(Client) Phone Number: *

(Client) Cultural Identification: *

Details of Referral: *

Upload File (Further Relevant Information): *

Max file size: 20MB

Referred By (Organization): *

Type of Referral: *

Self Family / Whanau Agency

Name (Referrer): *

First

Last

Relationship to Client: *

Email (Referrer): *

Phone Number (Referrer): *

I give informed consent for this referral and to the service to be provided: *

Yes I Consent

How did you hear about The MATES Organisation? *

Radio Website Family / Whanau Word Of Mouth Other Organization

Further Information / Comments / Feedback *

Thank you for your referral, MATES will contact you shortly *

Yes, please send me further information / updates

Submit

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