Contact us | Whakapā mai

Basic info

• First name *
• Last name *
• Location *
• Date of birth *
• Ethnicity *

Contact details

• Email *
• Phone number *
• A duty counsellor will call you to arrange an appointment.
• Is it OK to leave message? (optional)

  Yes *

  No *

Your gambling

• Do you feel you currently have a problem with gambling? *

  Yes *

  No *
• Do you feel you have ever had a problem with gambling? *

  Yes *

  No *
• Have you ever felt the need to bet more and more money? *

  Yes *

  No *
• Have you ever had to lie to people about how much you gambled? *

  Yes *

  No *
• Your primary gambling mode(s):
• Casino Table Games

  Casino Pokies

  Pub Pokies

  Club Pokies

  Tab Sports Betting

  Tab Track Betting

  Lotto

  Keno

  Scratchies

  Housie

  Other
• If you selected 'Other' above, please specify: