Make a Referral

You can refer to Dementia Support Australia by using the online referral form below.

Alternatively, you can make a referral by phone on 1800 699 799 or by fax on 1800 921 223.

If you are experiencing a medical emergency, please call 000.

DSA Referral form

Referrer's Details
Next of Kin/Guardian Details
Ongoing Contact Person Details
Person with Dementia's Details
Please upload any relevant documentation to support the referral (eg. Medicine/behaviour charts, relevant documentation from geriatric specialists, etc.)