Make a Referral
However you have found your way to us, we are really glad you did. Just a few questions so we can get this to the right person and make that first contact feel easy.
Who is this referral for?
*
Myself
My child
I'm making this referral on behalf of someone else
How are you connected to them?
A professional involved in their care
Their employer
Your details
First name
*
Last name
*
Email
*
example@example.com
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Your role or organisation
About the person you are referring
Your child's details
Their first name
Their last name
Their date of birth
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Month
-
Day
Year
Date
Your relationship to them
Their email
Their phone
Would you like us to contact you to discuss this referral first?
No, please go ahead and contact them
Yes, please contact me first to discuss
When you submit this form, the person you're referring will receive an email letting them know a referral has been made and what happens next.
If you'd like, please provide a brief overview of why support is being sought
How are you hoping we can help?
Funding
How will sessions be funded?
Self-funded / private
Medicare (mental health care plan)
NDIS
Workplace program / EAP
Not sure yet
How is the NDIS plan managed?
Self-managed
Plan-managed
NDIA (agency) managed
NDIS participant number
Is there a support coordinator involved?
Yes
No
Support coordinator name
Please attach any relevant documents
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Support coordinator email
I understand Psychsense will use these details to make contact about starting support. If this referral is for someone else, I confirm I have their consent (or their guardian's) to share their details.
*
I agree
Submit referral
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