SOS Flannel Card Referral Form

SOS Card Referral Form

For Survivors of Suicide with a Connection to the Veteran Community

Full Name of Person or Family Referring

Don't fill out if you are self-referring

Phone Number

Email Address

example@example.com

Relationship to the Survivor

Organisation if applicable

Survivor / Family Being Referred

Full Name

your name if you are self-referring

Phone Number

Email Address

example@example.com

Suburb Region State

About the person you lost

Full Name:

Date of Passing if known

Date

Relationship to the Survivor

eg son partner mate

Was the person who died a veteran?

If not there a link to the veteran or defence community?

If Yes please explain

Are there children or young people impacted by the loss?

What kind of support might be helpful right now?

Eg: Help with practical stuff (meals, errands, GP visits) Support for kids or family members Unsure - just need someone to guide us, Other (please explain below)

Other

Consent: do you have permission from the survivor/family to refer them to The Flannel Project

Consent: I don't have permission yet, but I'm happy to help facilitate contact

Once received, a team member from The Flannel Project will be in touch to gently complete a brief needs assessment.

This helps us tailor support through the Stabilise - Grieve - Grow model, offering emotional, psychological, and practical