INDIVIDUALS REQUEST FOR SERVICES FORM

Please read this before submitting a referral:
 

  • We offer therapy (with a psychologist or psychotherapist) supported by a Dr (MOSS Psychiatry for ages 17yrs +) where needed. Our Dr is a mental health GP and not a psychiatrist and we are not able to offer psychiatry only services.

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  • If someone is wanting a Psychiatric assessment or medication monitoring ONLY please contact a service that offer this such as Practice 92.

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  • Our service doesn't specialise with ADHD and can't offer ADHD assessment or ADHD medication. Practice 92 or Dr Tony Hanne may be options or to search for other providers visit Home | Healthpages or Healthpoint.

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  • KIDS and YOUTH: Our in-person Child Psychotherapist is fully booked and we are not able to add people to her waiting list at this time while in Alert Level 4.

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  • Our online (ZOOM) Child Psychologist is able to see children and young people with low risk and has some availability at this time Mon - Fri.

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  • Our specialist mental health GP can see ages 17 years and older only and doesn't prescribe meds for ADHD.

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  • Our adult psychologists may be able to offer therapy for people who are experiencing anxiety and who have low - moderate risk to their safety.

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  • We are offering online apps only at Level 4 and 3.

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  • Depending on a person's needs and the resources available at Anxiety NZ the wait to see a psychologist may be 1 - 6 weeks.

    We may not be able to offer an appointment to all people wanting 1:1 therapy due to the support we provide, and the resources we have available at the time. 

    Anxiety NZ is not a crisis service for people experiencing urgent or high risk to their or others health or safety. If you need help urgently please visit I Need Help Now | Mental Health Foundation

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Thank you for your understanding as our team work hard to continue to provide services under Alert Level changes.

NEXT STEPS:

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The first step for assessment or therapy with a psychologist or Doctor is generally a referral from a GP, doctor, counsellor or other health professional. You can start with a self-referral however we may ask for more info. If you want to join the peer support group only please make a note on the form.
 
Not all people self-referring may be able to be seen due to clinician availability, the type of support needed and if someone is currently in crisis. *Please note we are not a crisis service - if you need immediate help call 111, or visit the mentalhealth.org.nz website >
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You might be seen faster if you also contact a health professional and ask for a referral. If you have seen someone in the last 6 months you can usually phone them to ask for one at no cost. They can refer on our website, by fax 09 849 2375 or reception@anxiety.org.nz 
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​Our free 24/7 National Helpline is 0800 ANXIETY ( 0800 269 4389)

Fields with an asterisk (*) are required if you want to submit the form.

Your preferred days and times for consistent appointments*
Will another referral from your GP, Counsellor, or Mental health worker be sent through?*
Your gender*
Funding for Assessment & Therapy*

Request sent.

People with low incomes may be able to get WINZ / Studylink funding for therapy:

Weekly income limits before tax

Single 16-17 years – $549.57

Single 18+ years – $676.61

Married, civil union or de facto couple (with or without children) – $1006.82

Sole parent 1 child – $766.47

Sole parent 2+ children – $807.54

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Caregivers of children needing support may receive funding (not income tested)

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If you prefer, you can download a printable form for emailing here.
Email your completed form to: reception@anxiety.org.nz

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