Brain Snapshot
A short educational self-questionnaire across the 14 networks. Your top three out of balance, plus a clear next step.
- No email required
- Browser-only, no data stored
- Educational orientation
For Providers · Referrals
Refer a patient.
The online form below takes about 4 minutes. We respond to referrals within one business day, and your patient hears from us within 48 hours of acceptance.
AHPRA-registered clinician-led
Clinical-grade qEEG hardware
Co-care with your GP & psychologist
Geelong · Camperdown · Australia-wide
Online referral form
Send us your patient online.
Please don't include sensitive identifying details that aren't necessary for triage. We'll request a full clinical summary via secure means once we've confirmed acceptance.
PDF referral template
Or use a downloadable PDF.
For practices that prefer to send referrals via secure email, we have a single-page PDF referral template you can fill in, sign, and email to thehealthybrainclinic@gmail.com.
We email the latest version directly so it's always current. The online form above is also fully sufficient — no PDF required.
What happens next
From referral to first appointment.
Referral acknowledgement
You receive a written acknowledgement that we've received the referral, and an indication of whether we're accepting (we may decline if the patient is outside scope or our caseload is full — we'll suggest alternatives).
Patient contact
Reception contacts your patient to schedule an initial consultation, send the intake form, and explain what to expect.
Clinical correspondence
With the patient's written consent, we send you a clinical summary after the initial assessment — qEEG findings (if completed), the proposed plan, and any flags worth knowing about.
Ongoing coordination
We continue to share clinical correspondence at structured intervals (typically post-reassessment) and welcome direct phone contact for clinical discussion.
For urgent or crisis-level presentations, please don't refer in via this form. Direct urgent mental-health presentations to your local Crisis Assessment and Treatment Team, or call 000 for immediate emergency response. Our work is non-urgent, scheduled care delivered alongside primary medical and psychological services.