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Home
About Us
Meet the team
Cronulla
Wollongong
Dapto
Woonona
Shellharbour
Camden
Our services
Presentations
Client Information
FAQ
Should I see a psychologist?
Refer To Us
NDIS Referrals
Contact
Careers
Blogs and Resources
COVID-19 Resources
Walk
Different
Referral Portal
Tell us about yourself
Who are you?
*
GP
Medical Specialist
Community Health Service
Corporate Client
Other
GP Referral
GP Referral Type
Mental Health Treatment Plan (6 sessions)
Mental Health Treatment Plan Review (4 sessions)
DVA
Service Type
Service Type
*
EAP
Workshops
Counselling/Therapy
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NDIS Plan Type
Hidden
NDIS Service Type
*
Self Managed
Plan Managed
Your Details
Your Name
*
First
Last
Your Email
*
Your Phone Number
*
Practice Name
*
Provider Number
*
Company Details
Name
*
First
Last
Phone
*
Email
*
Invoice emailed to:
Company Name
*
Address
*
Street Address
Address Line 2
City
State
Postcode
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Plan Manager Details
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Name
First
Last
Phone
Hidden
Practice/Company Name
Hidden
Address
Street Address
Address Line 2
City
State
Postcode
Client Details
Name
*
First
Last
Phone
*
Date of Birth (DD/MM/YYYY)
*
Email
Referral Details
Reasons for Referral
Existing/Provisional Diagnosis
Appointment Preference
Preferred Day
Monday
Tuesday
Wednesday
Thursday
Friday
Preferred Time
Urgency
Next 24-48 hours
In the next week
Non-urgent
Case Details
Please include details of the incident/client as necessary.
Incident details
Does the client require further sessions after the EAP program is complete?
Yes
No
Unsure
To be discussed with the psychology
Need some help?
Call:
(02) 4244 7054
Email:
admin@walkdifferent.com.au
NDIS Referrals
