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For referrers

Referral letter template

If it's easier than starting from a blank page, print this letter, fill it in by hand and send it by fax, or save it as a PDF and attach it in HealthLink or email. Your practice's own referral letter works just as well. This template is only a convenience, and nothing on it is clinical wording the clinic requires.

How to refer

In the print window, choose A4 and turn off headers and footers for the cleanest page. To make a PDF, choose "Save as PDF" as the printer.

Referral letter

To: The Psychiatrist at Outcome Health

Outcome Health Psychiatry
Ground Floor, 1 Chapel Street, Blackburn VIC 3130

HealthLink
Outcomeh
Fax
03 8822 4977
Email
clinicalintake@outcomehealth.org.au
Phone
(03) 8822 8444
Date
Patient details
Full name
Date of birth
Address
Phone
Email
Medicare number and reference
Referred for
  • Psychiatric assessment and ongoing care
  • One-off psychiatrist assessment and GP management plan
  • Adult ADHD assessment
  • Medication review
  • Patient is aware of and agrees to this referral
Referral period
Reason for referral

The presenting concern and what you're hoping we'll address.

Current medications

Name, dose and how long they've been taken.

Relevant history

Past mental health care, previous diagnoses, relevant medical history. Attach reports if you have them.

For ADHD assessments

Please attach current results. If anything is abnormal, please manage it before we book the patient in.

  • Bloods attached
  • ECG attached
  • Urine drug screen attached

Will you continue prescribing once the patient is stable?

  • Yes
  • No
  • I'd like to discuss it
Referring GP
Name
Practice
Provider number
Phone
Fax, email or HealthLink ID
Signature

Template from ohpsychiatry.org.au. You can use your own referral letter instead. Please address all referrals to ‘The Psychiatrist at Outcome Health’.

After you send it

Once it's sent, we acknowledge every referral in writing. The how to refer page explains what happens next, and For referrers sets out what we see and what we don't. You can also call us on (03) 8822 8444, and patients can send an enquiry directly.