Assessment Referral Form

We welcome assessment referrals from GPs, specialists, allied health professionals, schools, community organisations, carers, and other relevant referrers.

Please complete the form below to provide details about the client, the assessment required, and any factors that may affect the assessment process. This information will help our team understand the client’s assessment needs and make appropriate arrangements for care.

north brisbane psychologists vibe wellMental Health

Client Details

Name
MM slash DD slash YYYY

Services Requested

What assessments are you requiring?
Are there any temporary or permanent vision or hearing impairments that may affect the test results (e.g. blindness, low vision, hearing loss, or ear blockages)?
Are there any physical conditions, injuries, or illnesses that may affect performance during testing?
Are there any mobility or accessibility needs we should be aware of to ensure appropriate support is provided?

Referrer Details (if applicable)

Additional Information

Consent

Your Mental
Health Matters

Vibe Well Psychology provides a safe, welcoming and inclusive space where individuals of all ages feel supported and understood.

From therapy and assessments to personalised NDIS support, our compassionate team is here to walk you through every stage of life, helping you navigate challenges, build resilience and achieve your goals.