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Partner Notification & Lost to Follow Up

Partner Notification & Lost to Follow Up

Partner Notification is the process of informing sexual partners or people who inject drugs that they may be at risk of an infection.

Our service takes privacy very seriously. All information is encrypted, transmitted and stored securely.
Once the submission is received you’ll be contacted to verify the referral before any action is taken.

There are 3 sections to this form. In order to reach the right person we need information about you, the person to be notified and any possible ways we can contact them.
You may also provide this resource to your client. Please inform them that notification by us is strictly confidential.

This form may also be used by clinicians to refer people that have been diagnosed with a blood borne virus (BBV) and are lost to follow up.

Complete each section with as much detail as possible.

If you need assistance in filling the form or have questions please call a nurse on 1800 451 624.

indicates a mandatory field.

Information about you

Would you like to be informed of outcome?

Please provide details about how & when you tried

Information about the person to be notified

Please provide as much information as possible even if it's partial. This will influence the success of partners being notified.

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Acknowledgement of Country

The Sexual Health Infolink acknowledges the Gadigal people of the Eora Nation as the Traditional Custodians of the land and waters where our offices are located. As a state-wide service, we further acknowledge the diverse Aboriginal peoples across New South Wales and their continuing connection to Country and culture. We pay our respect to Elders past and present.

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