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 with the web address and title of the form. Unfortunately, we are unable to host non-WVPHN forms directly on our website.

Alcohol and other drugs

Chronic conditions

Cancer Supportive Care GPMP

Diabetes tool


General practice support

Hospitals and health services referrals and templates

Mental health


Psychological Therapy Services referrals

Psychosocial Support Program referrals

Specialists referrals

Last modified: 19 March, 2020