Third Party - Request appointment

Third Party Referral

For referring doctors - simply email your standard referral or DVA form D0904

made out to 'Veterans Psychology' to referrals@veteranspsychology.com.au

For other referrers - to request an appointment on behalf of your employee or client, please complete the form below.

Note: Veterans Psychology is not a crisis service. If you are in crisis, call 000 or present to your local emergency department.

Client Information

Client First Name

Client Date of Birth required

Client Email

Does this client hold: Required

DVA White Card

DVA Gold Card

None of the above

Client Last Name

Client Address

Client mobile phone number

Briefly describe why this client is being referred, and if the client has any preferences regarding the psychologist they would like to see. These details help us match the client with the most appropriate psychologist for their needs.

Referrer Information

Referrer's name

Referrer's phone number

Referrer's email address

Referring Organisation

The client is aware of, and consents to, this referral being made.

I consent to the information provided being used by Veterans Psychology to identify and connect the referred client with a psychologist and/or psychiatrist. I understand that this information may be shared with the identified psychologist/psychiatrist or their practice administrator, who may contact the client to arrange an appointment. By submitting this referral, I acknowledge and accept Veterans Psychology’s Privacy Policy, available on our website.

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