GP Referral Form

PLEASE UPLOAD YOUR REFERRAL HERE

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Optional: Supporting documents for this referral

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Optional: GP Details (include if not in referral letter)

If you use Alias please write the Alias name & surname

Optional: Patient Details (include if not in referral letter)

Optional: Clinician requirements (include if not in referral letter)


Our contact Information

For any enquiries please contact us on

Phone: 03 9052 4872

Email: admin@telecare.com.au



“If your patient is actively suicidal, Telecare’s virtual care model may be insufficient for their needs. Please consider contacting the local crisis mental health team or advising them to present to the nearest Emergency Department.”