Referral Form for Professionals


There is no specific referral form. Referrals are accepted from any health professional e.g. general practitioners, the Community Mental Health Services, CADs (Community Alcohol and Drug Services), mental health workers, the Courts, ACC and school counsellors. The form below is intended for use by health professionals.

Referrals may also be sent as below:

Health link Care Select (EDI: anxietyt)

Fax: 09 849 2375


Post: PO BOX 411-33 St Lukes, Auckland

Clients may drop referrals to the clinic at 77 Morningside Drive, St Lukes (within opening hours).

Self-referrals may be considered – further information may be sought from a health professional.

Family member referrals for children / young people also considered. Please contact for more information on 09 846 9776 or email as above.

Your Name (required)

Your Email (required)

Your Organisation (required)

Referral Reason (required) - presenting issue, history, meds if known

Patient's Name

Patient's Contact Details

Patient's Date of Birth (required)

Nature of the problem

Duration of current problem