New Client Application Form
Complimentary 6 Week Frontline Program with Trek2Health
Your contact details
Select your preferred training quarter/dates



Please agree to terms
Your service
Our services are available to current or ex-serving Emergency Services personnel and Veterans.







Your Referrer / Support Contact

Please provide details for a referrer or support contact. This may be your supervisor, G.P., HR contact, wellbeing officer, or another health/support professional.

Your referrer or support contact will be contacted before moving forward with your application. Please ensure they are aware and contactable on the details provided.

If you are unsure who to list, or have privacy concerns, please still submit the form. As these fields are required, you may write “TBC” in the referrer name, email and phone fields, and our team can discuss this with you first.

Referrer name
Referrer email
Referrer phone