Rural Health Connect GP referral form
Rural Health Connect is an online psychology platform with more than 100 psychologists with a wide range of interest areas available. Bulk billed and low cost options available.
We will call your patient within three days of receiving a referral and notify you when their first appointment is booked.
GP name:		<DrName>
GP Practice:		<LocationName>
	<LocationAddress>	
Provider number:	<DrProviderNo>

Patient name:		<PtFullName>
DOB:			<PtDoB>
Phone: 			<PtPhoneH>
Address:	<PtAddress>	

Date of referral: 	<TodaysDate>
Notes:	<Please enter any additional notes relating to this referral>	

Please attach mental health treatment plan and fax to 07 4573 1100
-Thank you –
Please contact us on 0407 692 377 for any assistance.
Rural Health Connect is a social enterprise committed to improving access to psychologists for all Australians