Enquire Now

This form is for making enquiries about support services. You can also contact us by phone at (03) 6228 9099 anytime during business hours or by email at Reception@langford.org.au.

Your name *

First

Last

Layout

Email

Phone

About you

• I am contacting Langford to find out about programs for me.
• I am contacting Langford to find out about programs for someone else.

Name or initials of the person *

To avoid duplication and make sure each enquiry is accurately recorded, please add the name or initials of the person you’re enquiring on behalf of here. If you’d prefer to keep it anonymous at this stage, you can use a pseudonym here.

What programs are you interested in?

• Community Access
• Supported Independent Living (SIL)
• Respite (Short & Medium Term)
• Specialist Disability Accommodation (SDA)
• Children, Youth & Families
• Community Hub
• Other

Please provide some details about what you are interested in:

How did you hear about Langford? *

• Social Media (Facebook, Instagram or LinkedIn)
• Web search (Google, etc.)
• Printed ad or flyer
• Word of mouth
• Disability Expo
• Other

Privacy

As part of our enquiry process, Langford will collect and store names, contact details and other personal information shared with us about the enquiry. We will keep any personal information shared with us safe and confidential. Visit the Langford Privacy Policy for more information about how we collect, handle, and respect the personal information of users of this website.

Privacy Policy Agreement *

• I agree to Langford collecting and storing my personal information for this enquiry.
• I am enquiring on behalf of someone else and confirm I have their consent to share their personal information for this enquiry.

Submit

• Please do not use to form to apply for a job with Langford or to seek information about employment with Langford. Visit our Careers page for more information.
• Please do not use this form for business marketing purposes. Business enquiries may be sent to communications@langford.org.au