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GP Referral – ADHD Assessment

For adult ADHD assessment and treatment recommendations (telehealth). Please complete as fully as possible.
Privacy & consent: This form collects health information for the purpose of specialist assessment and report back to the referrer. Ensure the patient has consented to share this information and understands how it will be used.
Tip: If you already have a referral letter, you can paste key content into the boxes below.
Interpreter needed?
Urgency
Thank you for your submission!
Your input is valued, and we will respond as soon as possible.
Error
Bad respond
Referrals should include patient identifiers, symptoms/diagnosis, current medications, and be signed/dated. Please email completed referrals to referrals@solasmind.com.au
Privacy Policy | Disclaimer | Data Handling & Telehealth | Complaints | Contact
SolasMind provides administrative support and referral coordination. Psychiatric services are provided by Dr Zelpha Kittler (AHPRA: MED0002332140) practising as an independent contractor through an approved clinical base.
0410 494 898 | fax: 03 9003 8012 | info@solasmind.com.au
Not for emergencies. If you are at immediate risk call 000. Lifeline 13 11 14.
AHPRA Registration: MED0002332140
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