Online Psychiatrist Referral

Referral for Psychiatrist: Assessment / Opinion & Management

Referral for Psychiatrist: Transcranial Magnetic Stimulation

ℹ️ Clicking submit will send referral to Bluebell Health & your patient if you have included their email. Your patient will be contacted by us within 3 business days. If your patient is unsure about starting treatment and wants more information, please note that and we will walk them through their options.

If you prefer a printable PDF you may download it here

ℹ️ Please select from one of the below options to bring up the appropriate online referral.

If you prefer a printable PDF you may download it here

Is this referral for a Psychiatrist assessment or TMS for depression? *

PsychiatristTMS

A TMS referral includes a Psychiatrist safety assessment & reviews

TMS or Private Referral Reference

Patient Information

Patient First Name *

Patient Last Name *

Patient Contact Number *

Patient Email

Patient DOB

Clinical history

Patient History *

❗To qualify for Medicare reimbursement, your patient must have a depression diagnosis. We do not treat patients without depression with TMS, but can help them find a TMS clinic that does.

Number of current/prior antidepressant trials *

Medication History

❗To qualify for Medicare, your patient must have trialled >2 antidepressants for an appropriate length of time as determined by the referrer. Patients who have not tried >2 antidepressants can still pay privately. We will discuss their options with them.

✅ Patients who are still using their 2nd antidepressant do qualify for Medicare. Most patients remain on their medications during TMS.

Other comments

Referrer details

Referrer First Name *

Referrer Last Name *

Referrer Provider Number *

Practice Name *

Practice Contact Number *

Practice Fax Number

Practice Email Address

Street Address *

Practice Suburb *

Practice Post Code *

Practice State *

I confirm that my patient has not had a prior course of TMS

I confirm that my patient has consented to be contacted by Bluebell Health to discuss treatment and/or book in for their assessment
*

Referrer Signature *

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Date *