Referral Form

    Details of the Person Requiring Support







    Details of Person Submitting this Referral (if not the same as above)


    Disclaimer: By completing this form, I consent to HICSS collecting and exchanging personal information about the Person Requiring Support with relevant third parties, for the purpose of assessing eligibility for services offered by HICSS. I confirm that I have the authority to provide this consent. I understand that the collection of information for this referral is voluntary and that HICSS is bound by Privacy Legislation.
    Yes, I Understand

    Contact HICSS

    Contact our friendly staff today to meet your goals to the best of your ability & become part of a supportive community. Call us on (02) 4030 8865 or email us at enquiries@hicss.au

    We service Singleton, Cessnock , Port Stephen’s, Newcastle & surrounding areas.