If you have had an amputation, are scheduled to have an amputation, were born with a limb difference, or are a parent, spouse or carer of a person with a limb loss or limb difference, you can request a peer support visit.

We will find a Peer Support Volunteer who will best match the information you provide us, so please fill out the form as well as possible.

  • Peer Support Visit Details

  • Contact Details

  • Amputation Level

  • Amputation Cause

  • Assistive Devices

  • Additional Information

  • Is there any further information you would like to share with us