Referral Form

Partners in Recovery Referral Form

Partners in Recovery South West Sydney have offices in Bankstown, Fairfield, Liverpool, Campbelltown / Camden, Wollondilly / Wingecarribee. Please make sure all information is completed for referrer and consumer. You can download a PDF version of this referral form by clicking here.

  • Eligibility Criteria

    Consumers must meet all 7 eligibility requirements to be eligible for PIR.
  • Details of person being referred to Partners in Recovery

  • Referrer's Details

  • National Disability Insurance Scheme

  • Mental health Information

  • Current Supports

  • Please select the boxes that best apply to the consumer:
  • Financial Situation

  • Please select the boxes that best apply to the consumer
  • Functional Capacity

  • Supports Needed

  • Other Conditions

  • Once your referral has been accepted by PIR it will be forwarded to the PIR Team closest to your location. At this time a Support Facilitation Officer will contact you for further discussion

    If you have any further questions please contact our Intake Office on the below number.

For More information

Contact: Danielle Quig Intake Officer at PIR SWS Phone: 1300 747 797 Email: Website: