Referral Forms and Templates

On this page you find all our referral forms and templates. If you can’t see one you would like please contact us.
Please take care when downloading templates into clinical software. Do not open Best Practice or Medical Director forms outside of your clinical software, as this will corrupt the file.  Download the Importing Templates into Clinical Software Tip Sheet if you are unsure.

Please select which HealthWISE service you are needing a Referral Form or template for:

Mental Health Services
Aboriginal Health
Priority Allied Health (PAHS)
Memory Assessment Program

For information about each service and its programs, please see the 'Our Services' menu at the top of the page.

Medical Memo

Medical Memo is a monthly e-newsletter for Health Professionals located throughout the New England and North West of NSW and South East Queensland.  If you would like to stay up to date with the latest information from HealthWISE about referral form updates, new services and programs in our region, please subscribe.

Mental Health

Primary Mental Health Access (PRIMA) supports the intake and allocation of clients in the HNECC region with primary mental health care services according to their mental health needs and geographical location. Focus for this program is on mild to moderate mental health disorders.
PRIMA provides a triage service to ensure that clients receive the right care, in the right place, at the right time within a stepped care framework. This includes determining the level of care for the client, ranging from low intensity services and face-to-face psychological services to more intensive clinical care co-ordination. The focus will remain on collaborating with GPs to ensure clients access the Primary Mental Health care they require.

I am a GP in the New England. Where do I refer my clients with a Mental Health Treatment Plan for primary mental health care?
Your referral will go to PRIMA Fax 1300 452 059 or via Medical Objects: HEALTHWISE MENTAL HEALTH. This includes services in Glen Innes, Armidale, Guyra, Uralla, Walcha, Inverell, Tenterfield, Warialda, Bingara, Moree, Mungindi, Narrabri, Wee Waa, Boggabri, Quirindi, Tamworth, Barraba, Manilla, and Gunnedah.

How will my referrals be managed by this triage service?
Your referrals will be assessed on a daily basis, Monday to Friday, by staff located within the New England region utilising a Commonwealth Department of Health decision tool. At times we may be required to contact you to clarify referral information. This is to ensure the client is directed to the most appropriate care, particularly if there are risk issues identified.

What will happen after my clients are assessed through PRIMA?
Depending on the level of care indicated by the assessment, clients will then be referred to the most appropriate HNECC funded primary mental health service provider. You will be informed of the outcome of the referral and can discuss any decisions with the PRIMA team.

Who are the local providers of HNECC PHN funded primary mental health services?
HealthWISE will be delivering psychological services, including services to Residents in Aged Care Facilities and clinical care co-ordination services in the New England region.

Where do I refer my client who requires urgent mental health care?
Clients requiring more crisis or urgent care should be referred to HNELHD Emergency Department. For continued support, clients are to be referred to HNE-LHD Mental Health Services by telephoning the Mental Health Line on 1800 011 511 or faxing 02 6767 8739.
A free GP support line staffed by psychiatrists is also available Monday to Friday, 9am-5pm on 1800 16 17 18.

The Hunter New England Central Coast Primary Health Network (HNECCPHN) commissioned the Primary Mental Health Access (PRIMA) service. PRIMA is provided by a combination of locally based and experienced primary care providers, including HealthWISE in the New England North West area, Hunter Primary Care (HPC) and Central Coast Primary Care (CCPC). The three organisations work together to provide this service with a single point of access for Primary Mental Health Services.

For more information on any of the above, please contact your local PRIMA service provider:
Email: mentalhealth@healthwise.org.au Phone 1800 931 540 or fax 1300 452 059

HealthWISE Mental Health services provide targeted psychological therapies to clients who are experiencing mild to moderate mental health disorders,
and who would benefit from short-term interventions.

Please note that HealthWISE is not a crisis service



Referral forms and information sheets for New England North West NSW

Indigenous Mental Health, Client Referral and Consent Form

Residential Aged Care

Early Years Outreach Clinic

Natural Disasters Self Referral Form and Information Sheet

Suicide Prevention Initiative - Aftercare (SPI)


Referral forms for Darling Downs West Moreton QLD -

HealthWISE Social and Emotional Mental Health Support for Aboriginal and Torres Strait Islander People Referral Form

Natural Disasters Self Referral Form and Information Sheet

Clinical Care Co-ordination Program Information Sheet

Lived Experience Program Information Sheet

Aboriginal Health

Priority Allied Health Services (PAHS)

EASTERN- Armidale, Glen Innes, Guyra, Inverell, Kootingal/Nundle, Manilla, Qurindi, Tenterfield, Walcha, Tingha
WESTERN - Barraba, Bingarra, Boggabri, Boomi, Gunnedah, Moree, Mungindi, Narrabri, Warialda, Wee Waa

Allied Health Referral Forms

Referral Form for Individual Allied Health Services under Medicare for patients with a chronic medical condition and complex care needs
Eating Disorder Care Plan

Memory Assessment Program (MAP)