Referral Forms and Templates

On this page you find all our referral forms and templates. If you can’t see one you would like please contact us.
Please take care when downloading templates into clinical software. Download the Importing Templates into Clinical Software Tip Sheet if you are unsure.

Please select which HealthWISE service you are needing a Referral Form or template for:

Mental Health Services
Aboriginal_health
Aboriginal Health
PAHS
Priority Allied Health (PAHS)
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Memory Assessment Program

For information about each service and its programs, please see the 'Our Services' menu at the top of the page.

Mental Health

HealthWISE Mental Health services provide targeted psychological therapies to clients who are experiencing mild to moderate mental health disorders,
and who would benefit from short-term interventions.

Please Note that HealthWISE is not a crisis service

CLIENTS WHO ARE ASSESSED AS HIGH RISK SHOULD BE REFERRED TO HNELHD MENTAL HEALTH.

GP mental health referral forms & information sheets

Suicide Prevention Initiative - Aftercare

Residential Aged Care

Early Years Outreach Clinic

Allied Health Mental Health

Mental Health Self-Referral Form - Drought

This service provides person-centred, psychological support and strength-based strategies for people whose lives have been directly impacted by the ongoing drought and are experiencing mild to moderate mental health symptoms. 
This service is currently being offered in Barraba, Gunnedah, Manilla, Quirindi, Tamworth and Walcha.  

Aboriginal Health

Priority Allied Health Services (PAHS)

EASTERN- Armidale, Glen Innes, Guyra, Inverell, Kootingal/Nundle, Manilla, Qurindi, Tenterfield, Walcha, Tingha
WESTERN - Barraba, Bingarra, Boggabri, Boomi, Gunnedah, Moree, Mungindi, Narrabri, Warialda, Wee Waa

Memory Assessment Program (MAP)

HealthWISE

HealthWISE