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Home
Services
Telepsychiatry
Telepsychology
What we can help with
Referrals
About Us
Our Mission
Our Team
Contact Us
Contact Us
Work With Us
Blogs
Call: 1300 959 942
FAQs
Home
Services
Telepsychiatry
Telepsychology
What we can help with
Referrals
About Us
Our Mission
Our Team
Contact Us
Contact Us
Work With Us
Blogs
Call: 1300 959 942
FAQs
1300 959 942
FAQs
HelloDoc Referral form
Referral Form
Referrer Details
Referrer is a:
(Required)
General Practitioner
Nurse Practitioner
Other
Name:
(Required)
Practice Name:
(Required)
Practice Email/Fax (Preferred way of communication):
(Required)
Address:
(Required)
Postcode:
(Required)
Phone:
(Required)
Provider No. :
(Required)
Referral date:
(Required)
DD slash MM slash YYYY
PATIENT DETAILS
First Name:
(Required)
Surname:
(Required)
Date of Birth:
(Required)
DD slash MM slash YYYY
Address:
(Required)
Postcode:
(Required)
Phone:
(Required)
Email:
Medicare Card (Medicare card & Ref no.):
Next of Kin, Contact No. and Name:
Reason for referral:
(select one):
Psychiatric assessment under 291
Private patient/ non-Medicare card holder
Review appointment for existing patient (MBS 293 or other relevant item number)
Details for referral:
(Required)
Past psychiatric history (including hospital admissions):
Medications:
Risk concerns:
(eg. suicidal ideation, past suicidal attempts, self-harm, forensic / police involvement, violence)
Please attach any documents here:
Files
Drop files here or
Select files
Max. file size: 20 MB, Max. files: 5.
*Please advise your patients to call us if they have not heard from us within 5 business days of sending the referral.
YOUR MENTAL HEALTH IS OUR
PRIORITY
Don’t Delay Getting The Mental Healthcare Attention You Need, Get A Referral From Your GP And Book An Appointment.
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