Referrals

Make a Referral

Service Referral Form

A few short questions so we know how to reach you and whether we're able to help. We'll go through everything else — dates, addresses and care needs — on the phone, with the person involved.

About you — the referrer

First Name*

Last Name*

Organisation

Email*

Phone*

Which of these best describes you?*

Your relationship to the person needing support

Optional — skip this if you're referring yourself.

How did you hear about El Rapha Cares?*

About the person needing support

Just enough for us to know whether we can help and how to reach you. We'll go through everything else on the phone.

Their first name*

First name only — we don't need a surname at this stage.

Suburb*

So we can check it's inside our service area.

Postcode*

Which service are you interested in?*

Best time for us to call you*

Before you send this

We use these details only to get back to you about this referral — nothing else.

How we look after it

We keep this form short on purpose. Dates of birth, addresses and care needs are better talked through on the phone, with the person themselves there.

We won't share what you send with anyone outside El Rapha Cares unless you ask us to, or the law requires it. If we don't end up working together, we delete it.

You can ask us what we hold, have it corrected, or have it deleted, any time — just email admin@elraphacares.com.au. Our Privacy Policy has the full picture, including how to make a complaint.

And you never have to use this form — you're very welcome to just give us a call instead.

I'm referring myself, or I have this person's permission to share their details with El Rapha Cares.*

Start Today

The right care starts here.

0406 409 149

Call Now Make a Referral

admin@elraphacares.com.au