Just fill in the form below and leave the rest to us. We'll call and confirm a time.

First Name *

Last Name

Contact Phone Number*

Email *

What is your preferred day to be contacted?*
MondayTuesdayWednesdayThursdayFridaySaturday (until 1pm)

What is your preferred time to be contacted? Note that the service finishes at 1pm on Saturdays.*
9-1111-11-33-5

*This information will only be used by our staff to establish a suitable time to call you. Understandably, we may call at a time you are unable to freely speak to us. We will ask you if it’s a suitable time and if not, we will rearrange the call for another time. We’re here to help when you are ready.

Choose three preferred times that suit you to meet with one of our counsellors. Don’t worry if you don’t know just yet, we will call you to confirm these times or make other arrangements.

Choice 1

Time:
Date:

Choice 2

Time:
Date:

Choice 3:

Time:
Date:

Help in other languages

If you need help, you want to be able to talk to someone who speaks your language. Interpreters are available for our services.

Through the Gambler’s Help network, Gambler’s Help Southern is able to provide free and confidential suppport in English, Arabic, Cantonese, Mandarin and Vietnamese, so you can talk to us in the language you prefer.

The following links will take you to the relevant information at the Gambler’s Help site