Clinical & Agency Referrals

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If you're a clinician, counsellor, work for a social service agency, or work in any profession that brings you into a direct, support-based relationship with a male survivor of sexual abuse - you may want to get in touch with us at MOSAIC.

Any survivor can refer themselves to us directly. As someone who is working to support a male survivor of sexual abuse in a professional capacity, you may want to refer that person to us directly, on their behalf. Of course, you will need that person's full consent to do so.
How Clinical & Agency Referrals Work
You can refer someone to us formally in two ways:
  • Download our Referral Form here. It's a PDF, so you'll need to print it out, scan it and email it back to us. You can also fax it to us on: 04 389 5050. Either that, or post it to us at: 
    MOSAIC,
    PO Box 7682,
    Newtown,
    Wellington 6021
  • Or, with your client handy, fill in our Instant Referral Form below. This reaches us straight away. We will then get back in touch with your client directly.

    MOSAIC's Instant Referral Form

    Please fill in all sections below, and then push the 'Submit' button.
    Referral Details
    Contact Details of Person Being Referred
    Diversity Indicators
    To ensure we are able to continue to fully meet the needs of a diverse group, it is important we are able to collect demographic information.
    Risk Indicator Information
    Clinical Information and Common Survivor Impact Indicators
    Referral Information
    Legal Pathway Information
    Please note: MOSAIC believes that making a formal complaint to the Police is entirely the choice of the individual, and we do not encourage/discourage anyone from this procedure.

"Sometimes the only answer people are looking for when they ask for help is that they won't have to face the problem alone. ”

- Mark Amend