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1. 이것이 비상 사태인 경우 전화
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2. 또는 가장 가까운 병원 응급실 (ED)로 이동
3. 또는 전화 지역 DHB 정신 건강 위기 팀
(CATT 팀)
근무 시간 이외에 도박에 대해 긴급히 누군가에게 문의해야 하는 경우 0800 655 654 또는 텍스트 8006로 도박 헬프라인으로 전화할 수 있습니다.
전화:
0800 862 342
이메일:
help@asianfamilyservices.nz
홈
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자료
AFS 팀
자원봉사
주소연락
Online Referral
Client Information
Please enter the required fields
Name
Date of birth
Phone number
Gender
Male
Female
Gender Diverse
Address
Address validated
Ethnicity
Admiralty Islander
Afghani
African American
African (NFD)
Aitutaki Islander
Albanian
Algerian
American (US)
Arab
Argentinian
Armenian
Asian (NFD)
Assyrian
Atiu Islander
Austral Islander
Australian
Australian Aboriginal
Austrian
Bangladeshi
Belau/Palau Islander
Belgian
Bengali
Bismark Archipelagoan
Black
Bolivian
Bougainvillean
Brazilian
British (NEC)
British (NFD)
Bulgarian
Burgher
Burmese
Byelorussian
Canadian
Caroline Islander
Celtic
Central American Indian
Channel Islander
Chilean
Chinese (NEC)
Chinese (NFD)
Colombian
Cook Island Maori (NFD)
Cornish
Corsican
Costa Rican
Creole (Latin America)
Creole (US)
Croat/Croatian
Cypriot (NFD)
Czech
Dalmatian
Danish
Dutch/Netherlands
Easter Islander
Ecuadorian
Egyptian
English
Estonian
European (NEC)
European (NFD)
Falkland Islander/Kelper
Fijian (except Fiji Indian/Indo-Fijian)
Fijian Indian/Indo-Fijian
Filipino
Finnish
Flemish
French
Gaelic
Gambier Islander
German
Greek (incl Greek Cypriot)
Greenlander
Guadalcanalian
Guam Islander/Chamorro
Guatemalan
Gujarati
Guyanese
Hawaiian
Honduran
Hong Kong Chinese
Hungarian
Icelander
I-Kiribati/Gilbertese
Indian (NEC)
Indian (NFD)
Indonesian (incl Javanese/Sundanese/Sumatran)
Inuit/Eskimo
Iranian/Persian
Iraqi
Irish
Israeli/Jewish/Hebrew
Italian
Jamaican
Japanese
Jordanian
Kampuchean Chinese
Kanaka/Kanak
Kenyan
Cambodian/Khmer/Kampuchean
Korean
Kurd
Lao/Laotian
Latin American/Hispanic (NEC)
Latin American/Hispanic (NFD)
Latvian
Lebanese
Libyan
Lithuanian
Macedonian
Malaitian
Malay/Malayan
Malaysian Chinese
Maltese
Malvinian (Spanish-speaking Falkland Islander)
Mangaia Islander
Manihiki Islander
Manus Islander
Manx
Marianas Islander
Marquesas Islander
Marshall Islander
Mauke Islander
Mauritian
Mexican
Middle Eastern (NEC)
Middle Eastern (NFD)
Mitiaro Islander
Moroccan
Nauru Islander
Nepalese
New Britain Islander
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New Georgian
New Irelander
NZ European/Pakeha
Maori
Nicaraguan
Nigerian
Niuean
North American Indian
Norwegian
NOT SPECIFIED
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Omani
Orkney Islander
Other African (NEC)
Other Asian (NEC)
Other (Not elsewhere classified)
Other (NFD)
Other Pacific Island Groups (NFD)
Other Pacific Island (NEC)
Other Southeast Asian (NEC)
Pacific Island (NFD)
Pakistani
Palestinian
Palmerston Islander
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Papuan/New Guinean/Irian Jayan
Paraguayan
Penrhyn Islander
Peruvian
Phoenix Islander
Pitcairn Islander
Polish
Portuguese
Puerto Rican
Pukapuka Islander
Punjabi
Rakahanga Islander
Rarotongan (Cook Is)
Romanian/Rumanian
Romany/Gypsy
Rotuman/Rotuman Islander
Russian
Samoan
Santa Cruz Islander
Sardinian
Scottish (Scots)
Serb/Serbian
Seychelles Islander
Shetland Islander
Sikh
Singaporean Chinese
Sinhalese
Slavic/Slav
Slovak
Slovene/Slovenian
Society Islander (including Tahitian)
Solomon Islander
Somali
South African
South American Indian
South Slav (formerly Yugoslav groups) (NFD)
South Slav (formerly Yugoslav) (NEC)
Southeast Asian (NFD)
Spanish
Sri Lankan (NEC)
Sri Lankan (NFD)
Sri Lankan Tamil
Swedish
Swiss
Syrian
Taiwanese Chinese
Tahitian (including Society Islander)
Tamil
Thai/Tai/Siamese
Tibetan
Tokelauan
Tongan
Torres Strait Islander/Thursday Islander
Tuamotu Islander
Tunisian
Turkish (incl Turkish Cypriot)
Tuvalu Islander/Ellice Islander
Ugandan
Ukrainian
Uruguayan
Vanuatu Islander/New Hebridean
Venezuelan
Vietnamese
Vietnamese Chinese
Wake Islander
Wallis Islander
Welsh
West Indian/Caribbean
Yap Islander
Yemeni
Preferred spoken languages
English
Chinese
Mandarin
Korean
Vietnamese
Japanese
Thai
Hindi
Referrer Information
Please enter the required fields
Who are you referring?
Yourself
A friend or family member (affected other)
A GP/Doctor or other service provider referring a patient
Please ensure you have permission to share this information with us
Are you an individual or agency?
Individual
Agency
Individual/Agency name
Referrer contact phone
Referrer email
Client Medical Information
Please enter the required fields
Name of GP/Doctor
Name of practice
GP/Doctor phone
GP/Doctor email
NHI number
Additional Details
Please enter the required fields
Current legal status in NZ
NZ Citizen
Permanent Resident
Working Visa
Student Visa
Visitor Visa
Name of next-of-kin
Email of next-of-kin
Current living situation
Living with others
Homeless
Own Home
Boarding house
Living with family/whanau
Currently smoking (in last 30 days)
Yes
No
Current employment status
Employed - working full-time
Employed - working part-time
Unemployed - not working
Family Information
Please enter the required fields
Is this person a parent/caregiver?
Yes
No
How many children are currently under their care?
How old are the children?
Do the children need support?
Yes
No
Reason for Referral
Please enter the required fields
What is the reason for referral?
Experienced gambling harm / Gambler
Affected by someone else's harmful gambling
Needs help with a mental health related issue
Other (social support)
Support needed
Problem gambling
Mental health issues
Generational relationship
Being social with others (group/activities)
Parenting
Legal issues
Alcohol and/or drug us
ACC eligible conditions (e.g. head injury)
My culture
Budgeting
Employment assistance/help finding a job
Couple's counselling
Peer support
Support with my wellness
Family violence issues
Education issues
Finding accomondation
Involvement with the legal system
Family/whanau and support people
Other (Please state)
Other support info
Would the Client prefer to speak to a male or female clinician/counsellor?
Male
Female
Any further details?
Please enter the required fields
Please use the box below to provide us with any further details that you think may be important.
Any further background information you can provide (i.e. the main issue of concern, or a program they/you may wish to attend).
Is this person a risk to them self or others (mental health organisations can attach a risk assessment and support plan); any medication the person is currently taking; any other agency who is currently involved, etc.
Background Information
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