Ready to make a referral?

To enable timely attention to your intake request if you could fill out your form with as much detail as possible. This will enable your amendment or clinical intake to be actioned quickly with us getting back to you with confirmation within 5 business days.

If you are an EXISTING PARTICIPANT with AJH and would like to request a new service, have a new plan, have funding and date changes or need contact details updated, please fill this form out.