Make a referral.

Complete the form below and we'll respond within one business day. Complex, forensic and high-risk participants welcome — including those who've experienced previous service breakdowns. Urgent and crisis presentations are prioritised. You can submit online, or print this pack to complete by hand.

Emailreferrals@therapymentalhealth.com.au

Phone0428 368 465

ResponseWithin 1 business day

Referrer details

Your name Role / title Organisation Referrer type Email Phone

Participant details

Participant name Date of birth Pronouns (optional) Phone (if contactable) Suburb State Cultural background (optional) Interpreter required? Living situation

NDIS plan details

NDIS number Primary disability / diagnosis (NDIS) Plan management Plan start date Plan review date

Plan manager details — if plan-managed

Plan manager / organisation Plan manager email Plan nominee / decision-maker Plan manager phone

Supports requested

Select all that apply.

Specialist Support Coordination Support Coordination Psychosocial Recovery Coaching Mental Health Support Work Complex Behaviour Support Crisis Prevention & Risk Management Forensic & Justice-Involved Support Clinical Support & Governance Hospital Discharge & Transition Housing & Tenancy Support Assistance with Daily Living Community Participation Capacity Building & Life Skills Not sure — please advise

Clinical & risk summary

Primary diagnoses / presentation Reason for referral & goals Known risks & safety considerations

Current treating team / case manager Referral urgency

Attachments

Attach the NDIS plan and any supporting documents. The more context we have, the faster we can respond. Accepted: PDF, Word, JPG, PNG.

NDIS plan Current approved plan (PDF) Clinical / psychiatric reports Assessments, treating-team reports Risk assessment Behaviour support or risk plans Court / forensic orders If applicable Other supporting documents Anything else relevant

Please email any supporting documents (NDIS plan, clinical reports, risk assessments, court orders) to referrals@therapymentalhealth.com.au with the participant's name. This lets us keep documents secure alongside the referral.

Consent

The participant (or their authorised decision-maker) consents to this referral and to Therapy Mental Health being contacted about it. Consent has been given to share relevant clinical and risk information for the purpose of assessment and support planning. I understand information is handled in line with Therapy Mental Health's privacy obligations and the NDIS Code of Conduct.

Signature (name) Date

Prefer to talk it through first? Call our intake team on 0428 368 465.