Complete the online YAppEE Registration & Agreement Form to access all the support and benefits of YAppEE, including full access to the mobile application and free phone counselling.

Alternatively, you can download and print this YAppEE Referral & Agreement Form, and submit the completed form to yappee@blackswanhealth.com.au.

Once you have submitted the form, one of the YAppEE team will contact you to complete your registration and provide you with a unique log-in code, which enables you to access the app.

Make sure you check your eligibility here before you register. If you are still unsure of your eligibility, contact us.

Register here:

* Required Field

Full Name*

Date of Birth*

Mobile Phone Number*

Email*

What date did you start working in your job (or what is your expected start date)?*

Which state do you live in?*

PARTICIPANT AGREEMENT

I understand all information shared between YAppEE call centre staff and myself is confidential and phone calls are not recorded. Information given to YAppEE staff will not be shared with any other services or individual without my specific written consent, except under the following exceptional circumstances;

  • I am at risk of being harmed by someone
  • I am at risk of harming myself
  • I am at risk of harming someone else
  • If they become aware I have committed a major crime which hasn’t been reported
  • They are directed by legislation or a court of law to release information

I understand that YAppEE is not a crisis mental health service and will not replace any other mental health support I may be already receiving.

I agree to YAppEE collecting and storing my information for purposes of service continuity, service evaluation (including deidentified research purposes) and measurement of effectiveness of the service provided to me. This may include being contacted for research purposes.
I understand, all written communication may be kept for the duration of the service allowing the counsellor to keep track of interactions and to evaluate the service provision as required.
I understand, the data collected may be used for auditing and quality improvement processes. The information may also be used for accreditation purposes in which case it will be de-identified to ensure privacy and confidentiality.

Consent to this Agreement

I am over 18 and I have read, understand and agree to the above conditions, specified in this Participant Agreement.I am the parent/guardian of the participant and I have read, understand and agree to the above conditions, specified in this Participant Agreement. (Only tick if participant is less than 18 years of age)

Contact information:

Phone: (08) 9201 0044
Fax: (08) 9201 0033
Email: info@blackswanhealth.com.au

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We acknowledge the ongoing support of the State Government of WA, which enables us to deliver this program for free to Perth residents living north of the river.
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