Self-Referral to RainbowYOUTH
Thanks for reaching out to get support from us! Please fill out the confidential form below and we'll get in touch within 5 working days. Please note that we are not a mental health or crisis service - our mahi is in supporting young people (and their whānau and friends) in exploring and accepting their sexuality, gender identity, or intersex status. For needs outside of this, we aim to connect rangatahi with accurate and correct information and services that will provide safe and respectful support.
Please visit our
transgender peer support page
if you're looking for
specific support gender identity, gender affirming healthcare and anything related to being transgender
We collect your personal information in order to allow us to get back in contact with you, enable easy information sharing between our support workers to work together on a support case, and in order to collect data around what people are accessing our services so RainbowYOUTH can better advocate for young people's needs. Providing some information is optional, but if you choose not to enter personal information, we'll be unable to provide specialised support. We keep your information safe by storing it in password protected software and only allowing certain staff to access it. You have the right to ask for a copy of any personal information we hold about you, and to ask for it to be corrected if you think it is wrong. If you’d like to ask for a copy of your information, or to have it corrected, please contact us at email@example.com
This doesn't need to be your legal name if you use a different one
How did you hear about our support service?
Peer support group
Recommended by a doctor/teacher/counsellor etc.
Bay of Plenty
Outside of New Zealand
What email address or number should we use to get in contact with you?
If you have any communication preferences, let us know them too!
What do you need support with?
Is there anything else we should know?
Should be Empty: