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Referrals

Road Trauma Support WA is a self-referral service. You do not need a referral from a medical or health professional to access our services. Contact us by email or call 1300 004 814 for assistance or complete the form below and someone from RTSWA will contact you.

Third-party referrals

You may know someone who you think would benefit from our service, this could be someone in your family, someone you know socially or someone you are supporting as a professional. You can either:

  • Encourage them to contact us directly for assistance; or
  • Request Road Trauma Support WA to contact them using a Third Party Referral form.

Please note Injury Matters’ Service Charter affirms our respect for a person’s right to choose and/or accept support, and their right to Privacy.

If there is someone you would like us to make contact with, you will need to complete a Third Party Referral Form with their signature, to provide consent for us to do this.

Self Referral

Self Referral

If you would like us to contact you, please complete the self-referral form below.

Your Details

I would like someone from Road Trauma Support WA to contact me.
Name
Name
First
Last
*RTSWA will do their best to contact you on the requested day, however, due to service demand this might not be possible. We will endeavour to contact you as soon as possible after the date.
If I am not available, please leave a voicemail or send an email:

Third Party Referral

Third Party Referral

If there is someone you would like us to contact, we require a completed third-party referral form with their signature to provide consent for us to do this.

Referrer's Details

Please provide contact information for the person referring someone to our service.
Referrer's Name
Referrer's Name
First
Last

Personal Details

Please provide contact information for the person in need of support.
Full Name
Full Name
First
Last
If they are not available, please leave a voicemail or send an email:

Road Trauma Details

This information will be used to ensure appropriate time of contact and counsellor suitability.
Relationship to Crash

Third Party Referral Form

Self Referral Form

Find out more

Injury Matters delivers the Road Trauma Support WA service through funding by the Road Trauma Trust Account and contract management by the Road Safety Commission.

We strive to be culturally sensitive as we represent the Western Australian community in our imagery.

Please be advised that our website or resources may contain images, videos, or voices of people who have since passed away.

If any material causes concern, please contact us on (08) 6166 7688.