Greylight Psychology GP Patient Referral Form

Greylight Psychology GP Patient Referral Form

HIPAA Encrypted
Patient Name

First NameLast Name
Additional Patient Details
Please upload documentation relevant to your patient (MHTP etc.)

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Privacy & Confidentiality

Greylight Psychology takes the privacy of your patient’s health information seriously. This referral form is transmitted securely using SSL/TLS encryption. Uploaded files are stored in a secure, password-protected account and accessed only by authorised clinicians for the purpose of intake and ongoing care.

By submitting this form you confirm that you have obtained the patient’s consent to share their Mental Health Treatment Plan and relevant health information with Greylight Psychology in accordance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles. If you have any questions about how we handle health information, please contact us at enquiries@greylightpsychology.com.au
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