Applying for the SOS Card

Kindly complete the form below to apply for the SOS Card. We aim to process all applications within 24 hours.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Who is SOS Card for?

eg: yourself, someone else?

Medicare number of SOS

Relationship to SOS

eg: Friend, Father, Sister etc

Date of Suicide?

When did love one die?

Are you an immediate family member or someone substantially affected by the suicide of a veteran?

(Please provide details):

Please describe how the suicide of the veteran has substantially affected you or the SOS:

SOS is the Survivor of Suicide

Please describe any specific needs or challenges you or the SOS are currently facing that we could help address:

Have you or the SOS received a diagnosis for a mental health condition related to the veteran's suicide or military service?

Have you or the SOS experienced financial hardship due to the circumstances surrounding the veteran's suicide?

Have you or the SOS been referred to or sought out grief therapy services following the veteran's suicide?

Do you or the SOS have difficulty accessing affordable healthcare services, including general practitioner visits?

Declaration:

By submitting this form, I confirm that all the information provided is accurate to the best of my knowledge. I understand that the information provided will be used to assess mine or the SOS eligibility for the SOS Flannel Card program.

IN AN EMERGENCY
Call the Ambulance or Police on 000.
If you or someone you know needs immediate support, please call Lifeline on 13 11 14, Beyond Blue on 1300 22 4636, QLife on 1800 184 527 or 13yarn.org.au on 13 92 76