Voices Clinic Online registration

The Voices Clinic

Clinic location: 642 Burwood Road, Hawthorn East, 3123

Postal address: Associate Professor Neil Thomas, Mail H99, PO Box 218, Hawthorn, VIC, 3122

Tel: 03 9214 4840 Fax: 03 9214 5260

Email: voicesclinic@swin.edu.au or visit www.voicesclinic.com.au

The Voices Clinic is a research clinic that provides a specialist clinical psychology service for people who experience hearing voices. The Clinic can provide one-off consultation and/or sessions of one-to-one self-management advice or psychological treatment, as a complement to routine care provided by the person’s GP, psychiatrist or mental health team.

The voices clinic offers sessions in person at our office in Hawthorn East, or online via video-link with our easy to use, secure online platform. Please indicate which is the preferred format for this referral:

Face to face (in our Hawthorn East clinic)
Online (via video-link)
To be determined based on client preference

CLIENT DETAILS:

Full name

Date of birth

Address

Street Address

Suburb, State, Post Code

Contact phone number

Email address

Brief details of reason for referral

What day-to-day problems are caused by hearing voices/referral reason (e.g. distress, social withdrawal, what unable to do)?

What does the person say causes/caused their voices (e.g. mental illness, trauma, persecution, spirits, unsure)?

Current psychiatric diagnosis/es

Current psychiatric medication

Past/ current psychological treatment (if any) e.g. what, when and how long for, outcome

Details of any significant risks of self-harm or harm to others of other relevant clinical details. e.g. stressors, trauma, substance use

REFERRER DETAILS:

Referrer name and address

Referrer contact phone number

Referrer email address

Referrer agency

Date of referral (dd/mm/yy)

As a next step, please indicate whether you would like us to:

Contact the client directly to arrange a consultation
Contact you (the referrer) first for further information/ to arrange