Next Step Referral Form

Please note, we are not a crisis service, if crisis assistance is required, please call Access Mental Health on 02 6205 1065 or emergency on 000

REFERRAL DETAILS

Referral will not be processed until a MHTP for client received by Next Step Intake team.

NEXT STEP SERVICES & ELIGIBILITY

(Please refer to Exclusion Criteria on CHN website)
Please consider for;
Eligibility - must meet all of the following:

PATIENT INFORMATION

CARER/GUARDIAN INFORMATION (if applicable)

REFERRAL INFORMATION

CONSENT – Patient or Parent/Guardian for a Child

Patient has been informed of the Mental Health services that ACT PHN provides. Patient understands the information provided in this referral is required to determine their eligibility for services. Patient consents to their de-identified information to be used for statistical purposes for ACT PHN and Department of Health.
Under 12’s Parent/Carer willing to participate in sessions (group and/or individual) to support child towards best outcomes.
Please ensure that both; the information provided is accurate and that the corresponding MHTP of the client is emailed through to Next Step intake, otherwise the referral cannot be processed (nextstepintake@catholiccare.cg.org.au).
Please call (02) 6162 6111 or email nextstepintake@catholiccare.cg.org.au if you require assistance or further information.