Psychology referral - Mindspan Clinical
Registered Psychologist-led practice
Online referral (fastest): intake.mindspan.com.au/intake/refer
Email: info@mindspan.com.au   Phone: 0451 614 155

Patient: <<Patient Name>>
DOB: <<Patient DOB>>
Address: <<Patient Address>>
Phone: <<Patient Phone>>
Medicare no: <<Patient Medicare No>>

Referred by: <<Doctor Name>> (<<Provider Number>>)
Practice: <<Practice Name>>
Date: <<Todays Date>>

Reason for referral:
<<Clinical Details>>

Funding: Medicare Better Access (MHTP attached) / Private / WorkCover / TAC / NDIS (self- or plan-managed) / DVA / Victims of Crime (FAS) / EAP

Mindspan Clinical acknowledges every referral the same business day and contacts the patient within 3 business days. Progress correspondence is returned at each course of treatment per Better Access requirements.