LETSS Wellbeing Call Referral Form

Thanks for referring your caller to LETSS! Please let the caller know that we aim to keep our calls to around 30 minutes or less so we can support as many people as possible. When you select a time slot below, think of it as a window of time—E.g. 5-6pm means we’ll call sometime within that hour. We appreciate your understanding!

LETSS Wellbeing Call Referral

Has Consent Been Provided to Receive a Call From LETSS?

Yes

If LETSS cannot reach the person to be called, should we leave a voicemail? (Please ensure the person to be called has agreed to this.)

Yes

Name of Person to be Called

Pronouns of Person to be Called

Phone Number of Person to be Called

Pronouns

Name of Referrer

Referral Organisation

Referrer Email Address

Number of Calls

Date of Call

Preferred Time of Call

Date of Call 2

Preferred Time of Call 2

Date of Call 3

Preferred Time of Call 3

Would you like feedback, via email, on whether we were able to connect with the person you are referring?

Yes

Further Details

If you are human, leave this field blank.

LETSS Wellbeing Call Referral Form

Contact Us

1800 013 755

LETSS@skylight.org.au

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This program is supported by funding from Adelaide PHN through the Australian Government’s PHN Program

LETSS Feedback Form

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