Online Triage Service

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Lets start with your name * This field is required.
Title
First Name
Middle Name
Last Name
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What brings you to the Joplin Clinic at this time?
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What is your primary funding arrangement for services?Please select only one option that best describes how your sessions will be managed or billed. This may include a payment method, funding program, or compliance arrangement like WDO. .
Medicare
Private Health Insurance
NDIS
Private (Self Funded)
Work Cover
WDO
Other
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Reason for Seeking TreatmentPlease select all the areas you'd like support with. This helps us understand your needs and connect you with the right clinician.
ADHD Coaching
Advocacy
Cognitive Issues
Addiction
Adjustment
Diagnostic Assessment
Ageing Concerns
Complex Trauma
Anger
Anxiety
Depression
Eating Disorders
Family
Financial Problems
Grief & Loss
Learning Difficulties
Loneliness
Obsessive Compulsive
Panic Attacks
Parenting
Post-Traumatic Stress Disorder
Relationship
Self-Harm
Sexual Issues
Sleeping
Stress
Suicidal Thoughts
Work Stress
Social Skills Training
Financial/Legal problems and or Fines
Other
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Contact Email* This field is required.
example@example.com
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Mobile Number* This field is required.
Please enter a valid phone number.
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Gender
Male
Female
Non-Bindary
Prefer not to say
Other
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Are you currently linked with a caseworker, lawyer, GP or other support worker?Provide their details below:
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Please enter your WDO number as issued by Revenue NSW
(You can find this in your WDO approval email or official documentation.)
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What type of WDO activity are you seeking to complete with us?(Please select one or more)
Counselling / mental health treatment
Psychological assessment (for mental illness grounds)
Case management / support letter
Other (please describe)
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If you selected 'Other', please describe the type of WDO activity you're interested inTell us more about the kind of support, treatment, or activity you're hoping to undertake as part of your WDO—feel free to describe it in your own words.
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Do you have a Centrelink reference number (CRN)?
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How are your fines currently being managed?
In enforcement
Under a payment plan
Unsure
Other (please describe)
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If you selected 'Other'. Please describe your current fines management arrangementLet us know how your fines are being handled if it doesn’t fit the listed options—this helps us understand how best to support your WDO.
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What is the total amount of fines you’re seeking to resolve through WDO support?
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Which WDO eligibility category applies to you?
Please Select
Please Select
Cognitive impairment
Serious addiction
Acute financial hardship
Homelessness
Other
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Please upload a copy of your fines statement or enforcement order from Revenue NSWIf you don’t have it on hand, please email a copy to WDO@joplinclinic.com.au as soon as possible to proceed with your intake.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Please specify any other information relevant to this referralUse this space to share anything else you'd like us to know—this might include preferences, past experiences, or practical considerations
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How did you hear about us?Let us know how you found Joplin Clinic—this helps us understand what’s working and how people are connecting with our services.
General Practitioner
Specialist
Family or friend
Social Media
Internet Search
WDO Sponsorship
Other
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Referrer Name
Name
Relationship
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Consent for Joplin Clinic to contact the person submitting this form* This field is required.I agree to allow Joplin Clinic to contact me and my referrer by telephone, email, or post. I understand that I will be contacted by an authorised representative of the clinic for the provision of information regarding the booking process. I consent to receive calls and relevant correspondence from Joplin Clinic using the information tended within this form. I understand that I can terminate my consent at any time by advising the clinic in writing.
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We'd love to get your support on our social chanels!Follow us online to stay updated on mental health resources, clinic updates, and community programs—your support helps us reach others in need.
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Referrer
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