I. By submitting this referral form, you confirm that the information provided is
accurate and complete to the best of your knowledge and that you have
obtained the patient’s consent to share their personal and health information
with The Melbourne Psychiatry Centre for the purpose of assessing, triaging
and managing their referral.

II. The information submitted through this form will be handled in accordance
with our Privacy Policy and applicable Australian privacy legislation. While we
take reasonable measures to protect information transmitted via this
website, no method of electronic communication can be guaranteed to be
completely secure.

III. Submission of this referral does not guarantee acceptance or an
appointment. All referrals are reviewed by our clinical team, and additional
clinical information may be requested where required.
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IV. Please do not use this form to communicate urgent clinical concerns or
emergencies. If the patient requires immediate mental health assessment or
is at imminent risk of harm, contact 000 or your local Mental Health Triage
Service immediately.