Expression of Interest Form

One-to-One Support Sessions

Keen for one-to-one support?

Filling out the form below is a simple way to let us know you're interested.

It’s not a commitment—just the first step in starting a conversation.

It also helps us understand what you’re looking for and make sure we’re the right fit to support you!

Name

First Name

Last Name

What are your pronouns?

Date of Birth

YYYY

Phone

(###)

###

####

Email Address:

What suburb do you live in?

If you don't live in the Perth metro area, that's okay - we can still provide online/phone support!

What is your preferred language to speak in?

What is your preferred contact method?

Would you like an interpreter?

Yes

What type of support are you interested in?

You can tick more than one!

Peer Support

Peer Mentoring

Workshops and Programs

Social Groups

If you're filling out this form on someone else's behalf, please include your own contact details too.

Include your name, phone number, email address and relationship to the person below:

What draws you to working with Peer Practice, and what kind of support are you hoping for?

Is there anything you'd like us to know that could help us support you better?

How did you hear about us?