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New Patient Referral Screening Form

Eligibility Screening

These questions help determine whether Lifepoint Clinic is a suitable service for this referral.

We are only able to accept new patients living within Western Australia. Please check with your GP for other referral options.
Please see your GP for a referral before submitting this form.
Please present to your nearest Emergency Department or contact the Mental Health Emergency Response Line on 1300 555 788
Our psychiatrists do not have inpatient admitting rights. We recommend a service with inpatient admitting rights. If you wish to discuss further, please email us at admin@lifepointclinic.com.au
We do not provide medicolegal services generally. If you wish to discuss further, please email us at admin@lifepointclinic.com.au

ADHD Assessment or Treatment

Please complete this section if the referral is for ADHD assessment or treatment.

Please be advised we will not be able to diagnose ADHD if patient is still under the influence or withdrawing from substances.  We will also not treat with stimulants for 5 years if the patient has a history of substance dependence.
Please be advised we will not be able to diagnose ADHD if patient has psychotic symptoms. We also will not treat with stimulants if there is a history of psychosis. We will not treat with stimulants if there is a history of BPAD unless under exceptional circumstances.
Please be advised these conditions will likely need your existing specialist clearance as part of the assessment before treatment can commence (if diagnosed with ADHD). The treatment may be delayed but our psychiatrists will speak to you about this during the assessment.
Please be advised these medications can affect ADHD medication treatment. We do not advise medicinal THC or benzodiazepines especially with ADHD medication. If there are potential drug interactions, this can negatively affect starting ADHD medication treatment.

Patient Details

Please provide the patient’s contact details so the clinic can review the referral.

Appointment Availability

Please let us know your preferred appointment times and location. Please note that child psychiatry appointments are only at our Willetton clinic.

Referral Review Acknowledgement

Please read and confirm before submitting your referral request.

Please allow up to 14 business days for your enquiry to be processed. Please also take a moment to review the clinic fees and Medicare rebates for appointments with our clinicians.

If you are experiencing a mental health crisis, please present to your nearest emergency department or call the Mental Health Emergency Response Line on 1300 555 788 (Metro) or 1800 676 822 (Peel) or 1800 552 002 (Country/Rurallink).

For urgent mental health help or advice for children and young people, please call CAMHS Crisis Connect on 1800 048 636.

In providing your personal information, you allow Lifepoint Clinic to use this information to facilitate the provision of the services stated. Please be assured we are committed to keeping your personal information secure. Find out more at Privacy Policy.

Important: Submitting this form is not an acceptance of the referral. This form is part of the referral review process. Our team will contact you once your referral has been reviewed.