Form cover
Page 1 of 2

Clinician Referral, Continuum Teletherapy and Allied Health

Thank you for referring to Continuum Teletherapy and Allied Health. Our reception team will contact the patient within 1 business day, and will come back to you within 2 business days with a booking or a reason if we cannot proceed. For urgent referrals, please also email reception@continuumteletherapy.com.au.

Continuum Health Group Pty Ltd is a registered NDIS provider (Registration ID 4-M39ECWP) for Therapeutic Supports, which covers our psychology and dietetics for participants aged 18 and over. Oral health consultations are private pay and are not funded by the NDIS. Medicare Better Access for psychology is currently available with Joanna Pandelidis, Clinical Psychologist. Fees and funding for every service are at continuumteletherapy.com.au/fees.

This form takes under 2 minutes to complete.

💡 New to Continuum? See our clinician FAQ, including what happens after you refer and whether you will receive a report back.

Referring Clinician's Name

Practice Name

Email Address

Best Contact Phone Number

Patient First Name

Patient Last Name

Patient Date of Birth

Patient Contact Number

Patient Email Address

We use this to match the patient to their record. If the patient does not use email, enter the carer or guardian's email.

Is this patient NDIS-funded?

If yes, please tell us how their plan is managed. We can see agency managed, plan managed and self managed participants.

A
B
C
D
E

Does the patient have a carer, guardian, or support coordinator involved in their care?

A
B

Reason for Referral

Urgency

Urgency guide

🟢 Routine
Patient is stable, no immediate risk. Appointment within 4 to 6 weeks is acceptable.

🟡 Within 2 weeks
Time sensitive need but not in crisis. For example an upcoming NDIS plan reassessment, or a condition that is deteriorating and should not wait.

🔴 Urgent
Requires attention within 48 to 72 hours. For example acute pain, patient at risk, or an NDIS plan about to expire.

Services Requested

Psychology and dietetics can be NDIS funded. Oral health is a private service and is not funded by the NDIS.

Additional Notes (optional)

Consent confirmation

By submitting this form, you confirm that you have obtained the patient's (or their guardian's) verbal or written consent to share their information with Continuum Teletherapy and Allied Health for the purpose of coordinating care. Information is handled in accordance with our Privacy Policy and the Australian Privacy Principles.