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Patient Demographics
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Referring Medical Practitioner
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Patient Medical Information
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PROFESSIONAL PRACTITIONERS ONLY

In order to make an appointment with one of our Psychiatrists or Psychologists, our practice will need to receive a signed and dated referral from your Medical Practitioner.

This can be forwarded through Medical Objects, Fax, Email, Secure Messaging or Post . If the Clinic is not in possession of an appropriate referral, we will be unable to process any request for a Psychiatrist or Psychologist appointment. Your referral will need to include all relevant contact details including a current phone number and if possible an email address. Upon receiving the referral, the Clinic will then allocate the assessing practitioner and liaise with yourself so as to arrange the details of the initial appointment. 

Due to cross-disciplinary procedural differences, several of our Psychologists are free to accept self-referrals, so contacting the Clinic and discussing appointment availability may be an appropriate first step in consulting a Psychologist. We encourage contact via phone 3892 1979 or via email : admin@yerongaclinic.com.au 

Online Patient Referral Form

Strictly for the use of referring practitioners only, please complete and submit our online form on this page.

Alternatively, print and complete this form which can then be scanned and emailed or faxed directly to our rooms