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
Priority Allied Health (PAHS)
Memory Assessment Program

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

RSVP essential: 
by 3 May 2019. 
Please contact Susanne Kable at HealthWISE Narrabri for more information: 6792 5514 or

When a child’s thoughts, feelings and behaviour are out of balance, and the child is unable to function or cooperate in an appropriate way for their age or situation, this child may benefit from a professional diagnosis and management plan.
As professionals, how are we coping with the demand for paediatric behavioural services? What resources and services do we need? Where do we find these resources and services?
HealthWISE and Western Sydney University invites health, education and community services professionals to join us for aninformation and Q & A session to explore these issues in our region.

When: Friday 10 May 2019
Time:   1.30pm – 8pm, afternoon tea & dinner provided
Where: Narrabri Aquatic Centre, Multi-Purpose, Room, Tibbereena St, Narrabri
Cost: FREE

Guest presenters:
Prof John Whitehall, Western Sydney University – Visiting Narrabri Paediatrician
Dr Jenny McDonald, Western Sydney University – Autism Spectrum Disorder
Assoc Prof Andrew McDonald, Western Sydney University – Behaviour disorders in children, in particular ADHD
Dr James Wick, Royal Far West Psychiatrist – Childhood and youth psychiatric conditions and assessment
Dagney Hopp, Royal Far West Occupational Therapist – Regulation Strategies for Children
Local Primary & High School Principals

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


GP mental health referral forms & information sheets

Referral forms and information sheets for New England North West NSW

Referral forms for Darling Downs West Moreton QLD

Suicide Prevention Initiative - Aftercare

Residential Aged Care

Early Years Outreach Clinic

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)