Stability Before Capacity
If you are self-referring, please complete the Contact Us form at samms.com.au. A member of our intake team will contact you to complete the referral process.
Triage Urgency *
Please Note
SAMMs is not an emergency or crisis response service. This referral form is not monitored in real time. If the participant is at immediate risk, please contact Emergency Services: 000 or Lifeline: 13 11 14
SAMMs will review this referral and aim to respond within 48 hours.
Informed Consent *
I confirm that the participant has provided informed consent for their personal information to be shared with Creating New Pathways for the purpose of this referral.
Participant Awareness *
Is the participant aware of and understands the following: Why they are being referred to SAMMs; What SAMMs is and the type of support provided; The role of a Complex Needs Clinician; That SAMMs is an independent service (not part of your organisation or standard employment/community services); That SAMMs works collaboratively alongside existing supports and does not replace them.
Gender Identity (optional)
Safe to leave a message? *
Interpreter required? *
Briefly outline what has prompted this referral.
Known Participant Barriers *
For triage purposes only. Final intervention pathway will be determined by SAMMs clinicians following assessment.
Alerts & Known Risks
Provide any further relevant risk details.
Current Supports & Services
Current Functional Capacity *
As observed by the referrer
Please include any further information relevant to this referral that has not been captured above.
If referring via Medicare, please contact SAMMs directly to process submission.
Funding Details
Financial Approval *
Approval Scope
If unknown, leave blank — SAMMs will determine the appropriate service scope following clinical triage.
Financial Responsibility *
Invoicing Method *
Accounts Contact
Billing Contact Details
Cancellation & Non-Attendance
Less than 48 hours notice may incur full session fee. Repeated non-attendance may result in review or closure of referral.
Scope & Service Boundaries
Services are delivered within approved funding, scope, and clinical suitability. Additional sessions or extensions require further approval.
Service & Financial Conditions
SAMMs reserves the right to pause services where payment is outstanding, reallocate sessions where funding is not confirmed, adjust servicing where approved scope or budget is exceeded. Payment terms: 7–14 days unless otherwise agreed.
Full terms and conditions: samms.com.au
Referrer Declaration
Supporting Documentation
Service Agreements, Funding approvals, Reports/assessments, Risk plans. PDF, Word docs, images accepted. Max 10MB per file, up to 5 files.
If your organisation requires SAMMs to be registered as a new supplier, please attach required onboarding documentation.
Click to upload files
PDF, DOC, DOCX, JPG, PNG
