Patient Referral

Complete the form below to submit a referral. Referrals can be submitted by either the patient or the referring practitioner.

Referrer Details

GP / Healthcare Practitioner Name

Practice / Clinic

GP Provider Number

Patient Details

Patient Name

Date of Birth

Preferred Clinician

No clinicians are available at the moment. Please contact the clinic.

Referral Letter

Supporting Documents

Examples include:

Previous specialist letters
Previous psychologist report
Mental Health Care Plan
Relevant investigation results
Current medication list
ADHD questionnaires or school reports
Other