We currently have precautionary measures in place to protect our patients and staff. Read more

  • Medical professionals can submit a referral form online. Complete the details below and once submitted, the referral form will be automatically sent to
  • For further enquiries, please email or phone (03) 9508 5100.
  • Patient Details

  • DD slash MM slash YYYY
  • Health Fund details - If known

  • Please enter a number from 1 to 1.
  • Next-of-kin details - If known

  • Referring Psychiatrist/GP details

  • Reason for admission

  • Any other relevant details

  • Max. file size: 64 MB.
  • Max. file size: 64 MB.