NDIS Referral Form

    Myself to PsychCentralSomeone else to PsychCentral

    Residing AddressGroup HomeHospitalAged Care Facility



    NDIS Plan Information



    Your Information



    Participant Information





    Residing Address



    Group Home






    Aged Care Facility







    YesNo - any time is fine

    Got a Criminal Record?Spent time in prison or a forensic hospital?Shown aggressive or challenging behaviour?N/A



    Finding and Keeping a JobImproved LearningImproved Health and WellbeingImproved RelationshipsSchool Leaver Employment SupportImproved Daily Living

    NDIASelf-ManagedPlan Managed

    NDIASelf-ManagedPlan Managed

    NDIASelf-ManagedPlan Managed

    NDIASelf-ManagedPlan Managed

    YesNoCurrently RequestingN/A

    NDIASelf-ManagedPlan Managed

    NDIASelf-ManagedPlan Managed



    Referrer Details




    NDIA ManagedSelf-ManagedPlan Managed

    Support coordinatorMedical professionalFamily/friend/colleaguePrevious PsychCentral Group clientGoogleSocial mediaDirectly from PsychCentralOther


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      About PsychCentral

      PsychCentral is a professional psychological and allied  health service tailored to meet the needs of culturally and linguistically diverse (CALD) communities. We conduct assessments, treatment plans and interventions for individuals, couples, and families in a variety of clinical, forensic, school, disability, and work-related settings.


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      Bankstown Head Office
      Level 8 66-72 Rickard Rd,
      Bankstown, NSW 2200

      Telephone: (02) 9793 7762
      Fax: (02) 9793 7925
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      To view our other clinics, Click HERE.