Refer your clients to us
for an ADHD assessment

Refer your clients to us
for an ADHD assessment

Please fill out the form below and include as much relevant information as possible so our team can arrange the right next step. We aim to be in touch within 24 - 48 hrs.

Please fill out the form below and include as much relevant information as possible so our team can arrange the right next step. We aim to be in touch within 24 - 48 hrs.

This referral is for allied health, psychologists & therapists only.

This referral is for allied health, psychologists & therapists only.

All medical referrals, please refer to us via your PMS.

All medical referrals, please refer to us via your PMS.

Client Referral Form

Client Referral Form

Suitable for: Adults with a suspected but undiagnosed presentation. For acute risk or complex psychiatric comorbidity, please continue to use your usual specialist mental health pathway.

Suitable for: Adults with a suspected but undiagnosed presentation. For acute risk or complex psychiatric comorbidity, please continue to use your usual specialist mental health pathway.

Fields marked * are required.

Client Information

Client Information

TITLE

GENDER

DOB *

FIRST NAME *

MIDDLE NAME

LAST NAME *

PHONE NUMBER *

EMAIL ADDRESS *

ADDRESS *

Reason for Referral

Reason for Referral

PRESENTING OBSERVATIONS *

OTHER RELEVANT INFORMATION *

Referring Practitioner

Referring Practitioner

PRACTITIONER ROLE *

NAME OF PRACTITIONER *

NAME OF PRACTICE OR ORGANISATION *

PRACTITIONER PHONE *

PRACTITIONER OR ORGANISATION PHONE *

PRACTITIONER EMAIL*

PRACTITIONER OR ORGANISATION ADDRESS *

I confirm I have obtained the client’s consent to make this referral and share the information provided.

I confirm I have obtained the client’s consent to make this referral and share the information provided.

We aim to be in touch with clients within 24 - 48 hrs.

About ADHD

Assessments & Treatment

About Us

Refer a Client

Log In

Book an ADHD Assessment

About ADHD

Assessments & Treatment

About Us

Refer a Client

Log In

Book an ADHD Assessment

LOCATIONS

New South Wales

South Australia