Referral Form for Parents and Health Professionals



We offer free services (if you have a Medicare card with your baby listed) to support parents and families across NSW. Our services include: 

  • Parenting centres
  • Residential services
  • Mental health services
  • Toddler clinics
  • Kids behaviour clinic
  • Virtual home visits and residential stays
  • Virtual breastfeeding clinic
  • Parenting webinars
  • Community programs

All our services are evidence-based and delivered by a highly-trained multidisciplinary team of child and family health nurses, perinatal and infant nurses, mental health nurses, paediatricians, GPs, social workers, psychologists and psychiatrists.

If seeking support, simply complete the referral form and our team will be in touch to organise the right services for you and your family.

Parents - please select ‘self-referral’ from the profession drop down list.

Or, to book your free one hour virtual breastfeeding clinic consultation here.

This application is to be completed by health professionals only. Families cannot self-refer. Once your referral has been processed your client will receive a text from our team to contact Intake and action their referral. 

Family Details

Parent or Carer (That will attend Karitane)

Alternative Parent or Carer Details

Presenting Child/ren Details



Reasons for Referral

Other Specialists

EDS Form

Referring Agent

Required fields are marked with a *

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