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Referral Form (BSRS)

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The Bereaved by Suicide Response Service (BSRS) COVID 19 Online Response is a free national online and phone service to provide brief specialised therapeutic support for people bereaved by suicide in the context of Covid-19 and associated restrictions.

Please see BSRS COVID 19 Online Response Service Information Sheet and www.casa.org.nz for further information about this service.

Type of referral

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Referral Information

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Bereaved Contact Information

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Please let us know your email address.
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Bereaved Demographic Information

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If the referred person is aged under 16 years, please include name and contact details of parent or caregiver

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Key Information about the Bereavement

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Once referral is confirmed contact with the bereaved will be initiated within two working days.

If we have been unable to connect with the bereaved within a fortnight, we will get back to you and let you know.

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