GP Referral
Please enter referral details below. You will receive a copy of the referral via email for your records.

If you have informed consent from your patient, the MSRS Intake Worker will contact your patient within 2-3 business days. We will also advise you once we have made contact with your patient.
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Email *
GP Name: *
GP Clinic Name: *
GP Contact Number: *
Patient's Name *
Patient's Date of Birth: *
Patient's Contact Number: *
Suburb or postcode where client currently lives:
Medication(s) of Concern: *
Consent Obtained for Referral *
*Please note: we can't proceed with referrals if the client hasn't provided consent. To speak with us about this, call 1800 931 101
Is the patient at risk of harm to self or others?
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If yes, please provide details:
Does your patient require an interpreter?
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How did you hear about us? *
Thank you for your referral to the MSRS. You will receive a copy of your referral via email. The MSRS Intake Worker will contact your patient within 2-3 business days and advise you of the referral outcome.
A copy of your responses will be emailed to the address you provided.
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