Templates

Please see below a list of templates available from this website or via external provider websites.

Please note: Western Victoria PHN (WVPHN) welcomes the opportunity to provide online links to GP Referral Templates for specialists or primary health care services in our region. If you wish to have a link to your referral form included on this page, please email communications@westvicphn.com.au with the web address and title of the form. Unfortunately, we are unable to host non-WVPHN forms directly on our website.

Chronic conditions

Cancer Supportive Care GPMP

• See the Cancer Support page

Diabetes tool

• Australian type 2 diabetes risk assessment tool (AUSDRISK)

General practice support

• Health assessment proformas
• Centrelink Medical Certificate Form

Hospitals and health services referrals and templates

• Grampians Health 
• Barwon Health
• Epworth Geelong

Mental health

headspace

• headspace Ballarat referral

Psychosocial Support Program referrals

• See the Psychosocial Supports page

Specialists referrals

• Nerve Conduction Study –  Professor Peter Gates