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Home
About Us
Meet the team
Camden
Cronulla
Dapto
Shellharbour
Wollongong
Woonona
Our services
Medicare Services
NDIS Services
Corporate Services
Presentations
Client Information
FAQ
Should I see a psychologist?
Refer To Us
Referral Form
NDIS Referrals
Contact
Careers
Blogs and Resources
COVID-19 Resources
Walk
Different NDIS
Portal
NDIS Plan Type
Funding Source
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Self Managed NDIS Client
Plan Managed NDIS Client
GP Referral
Private Billing
Do you have a preferred psychologist?
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Adrian Comensoli
Martin Daly
Sarah Gellatley
Mollie Snelling
Michelle Wills
Hamish Simpson
Natasha Rodgers
Do you have a preferred location?
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Cronulla
Dapto
Wonoona
Wollongong
Shellharbour
Plan Manager Details
Name
First
Last
Phone
Practice/Company Name
Address
Street Address
Address Line 2
City
State
Postcode
Client Details
Client Full Name
*
First
Last
Phone
*
Date of Birth (DD/MM/YYYY)
*
Email
NDIS Screening
1. You are the client's:
Parent
Guardian
Carer
Support Worker
Your Name
*
First
Last
Your Phone Number
*
Email
*
2. Has the client's permission been obtained to make this referral?
*
3. What is the client's diagnosis and severity of their condition?
4. Has the client been previously treated for this condition by a psychiatrist/psychologist?
Yes
No
5. If answered yes to question 4, what was the duration, frequency and outcome of this treatment, if any?
6. Please list anyone else involved in the client's treatment (GP, psychiatrist, OT etc) If so, how often do they see them?
7. What are the specific goals that the client wishes to address in counselling sessions?
8. How comfortable is the participant in being outdoors and interacting in social settings?
9. How likely is the participant to stay with the clinician during the session?
10. Describe the client's communication skills:
11. Does the client engage in any violent behaviour (swearing, hitting etc) towards themselves or others, and if so, please describe:
12. Does the client have meltdowns and if so, please describe the nature and any known triggers for the client's meltdowns:
13. How frequent, if any, are the client's meltdowns?
Multiple times a day
Once a day
Few times a week
once every week/s
14. What support have the parents/guardians/carers sought to identify and manage any behavioural issues?
15. Please outline why you/the client has chosen an outdoor service over an indoor one?
Has there been any behavioural managed plans developed for the participant, and if so please upload here or bring to the first session:
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