Self-Referral Form

For self Referrals

If you think JustACE can support you, you can fill out this form to refer yourself to the program.

Before completing this form, are you:

18 years and older?

Experiencing cognitive impairment or difficulties with: Thinking, Communication, Emotions, or behaviour?‍

Are you: on custodial remand or the Magistrates Courts Diversion List?

If yes, please continue.

If you are unsure or have any difficulties filling out the form, please contact us for further support.

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Online Referral Form

To access and fill in our self-referral form, please click the button below or click here.