Please fill in the following details and we will get back to you by phone (or email) by the next business day and arrange a face-to-face appointment. Most appointments can be made within a week.

If you need urgent help, then please call Lifeline on 13 11 14, Mensline Australia on 1300 78 99 78 or Kids Helpline on 1800 55 1800. Menslink is open during business hours and can't provide after-hours crisis support.

* 1. Name

* 2. Age (don't forget our age restrictions)

* 3. Contact number

* 4. Email?

* 9. What are the main areas you would like Menslink to help with?

  Low priority Medium priority High priority
Confidence & self-esteem
General happiness and/or depression and sadness
Relationships (partner)
Relationships (friends)
Relationships (family)
Managing strong emotions (like anger)
Anxiety and/or stress
Bullying 
Resilience (not getting upset when things don't go well)
Alcohol or drug use
Grief or loss 
After effects of a traumatic event/time in your life (PTSD)
Spending too much time online (social media, games, porn)

* 10. Ever been affected by any of the following?

* 11. Please indicate if you have ever been affected by:

  As a direct victim As an indirect victim / witness Have done it yourself
Family or domestic violence: Physical
Family or domestic violence: Psychological / emotional abuse (e.g. verbal abuse, intimidation, control)
Sexual abuse
Other violence (school, on the street etc)
Psychological / emotional violence (e.g. verbal abuse, intimidation, control)

* 12. Please indicate whether you have been affected by any of the following:

* 14. Please give us some general background including how think we can best support you 

* 15. Is there anything else, including any legal issues we should be aware of?

* 17. By ticking this box I consent to Menslink collecting personal data for anonymous statistical purposes and storing this information offshore.

T