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.

Mental Health

The Hunter New England Central Coast Primary Health Network (HNECCPHN) has commissioned the Primary Mental Health Access (PRIMA) service to support the intake and allocation of clients in the HNECC region with primary mental health care services according to their mental health needs and geographical location. Focus for this program is on mild to moderate mental health disorders.

The PRIMA service is provided by a combination of locally based and experienced primary care providers, including HealthWISE in the New England North West area, Hunter Primary Care (HPC) and Central Coast Primary Care (CCPC). The three organisations will work together to develop this service, providing a single point of access for Primary Mental Health Services. As you can appreciate, this is a significant step in the mental health redesign process and we are aware that change takes time, and we appreciate any feedback to assist us in this development.

The new PRIMA Service will provide a triage service to ensure that clients receive the right care, in the right place, at the right time within a stepped care framework. This will include determining the level of care for the client, ranging from low intensity services and face-to-face psychological services to more intensive clinical care co-ordination. The focus will remain on collaborating with GPs to ensure clients access the Primary Mental Health care they require.

I am a GP in the New England. Where do I refer my clients with a Mental Health Treatment Plan for primary mental health care?
Your mental health treatment plan needs to be sent to: PRIMA Fax 1300 452 059 or via Medical Objects: HEALTHWISE MENTAL HEALTH. This includes services in Glen Innes, Armidale, Guyra, Uralla, Walcha, Inverell, Tenterfield, Warialda, Bingara, Moree, Mungindi, Narrabri, Wee Waa, Boggabri, Quirindi, Tamworth, Barraba, Manilla, and Gunnedah.

How will my patient’s mental health treatment plan be managed by this new triage service?
Your patient’s mental health treatment plan will be assessed on a daily basis, Monday to Friday, by staff located within the New England region utilising a Commonwealth Department of Health decision tool. At times we may be required to contact you to clarify referral information. This is to ensure the client is directed to the most appropriate care, particularly if there are risk issues identified.

What will happen after my clients are assessed through PRIMA?
Depending on the level of care indicated by the assessment, clients will then be referred to the most appropriate HNECC funded primary mental health service provider. You will be informed of the outcome of the referral and can discuss any decisions with the PRIMA team.

Who are the local providers of HNECC PHN funded primary mental health services?
HealthWISE will be delivering psychological services, including services to Residents in Aged Care Facilities and clinical care co-ordination services in the New England region.

Where do I refer my client who requires urgent mental health care?
Clients requiring more crisis or urgent care should be referred to HNELHD Emergency Department. For continued support, clients are to be referred to HNE-LHD Mental Health Services by telephoning the Mental Health Line on 1800 011 511 or faxing 02 6767 8739.
A free GP support line staffed by psychiatrists is also available Monday to Friday, 9am-5pm on 1800 16 17 18.

For more information on any of the above, please contact your local PRIMA service provider:
Email: Phone 1800 931 540 or fax 1300 452 059

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


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 throughout the New England North West.

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)