Circle of Support

Referrals

We provide in home and in clinic services to the Greater Brisbane Region & telehealth nationwide

Make a Psychology, Positive Behaviour Support or Social Work referral

Taking a few minutes to refer to Hively Health can change lives.

We can be referred to for Psychology, Positive Behaviour Support and Social Work services for NDIS and private clients – all ages and conditions.

We are a trusted and respected provider, dedicated to ensuring effective outcomes for those we support.

Please complete our referral form and a member of the Hively team will be in contact within 24 hours.

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Referral Form/Service Request

Please provide as much information as you can to assist with clinician allocation at Hively.

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Referrer Details

Referral Type

Referrer (Please provide details)

Self Referral

Name and Title of the Referrer

Organisation

Allied Health

Medical Practitioner

Medical Specialist

School

Support Coordinator

Other

Address

Contact Number

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Preferred Contact Person

Preferred Contact

Preferred Contact - Name

Preferred Contact - Phone Number

Preferred Contact - Email

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Client/Participant Details

Name(Required)

Date of Birth(Required)

Gender

Preferred Pronouns

Address

Contact Number(Required)

Email(Required)

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Parent/Guardian Details

Please fill out this section if the client or participant is a child, an adult under guardianship arrangements, or if there is an NDIS plan nominee in place.

Does the participant require a parent/guardian? (Please Select)(Required)

Yes

Name

Relationship to Client

Address

Contact Number

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Service Requirements

Service Required(Required)

Individual Therapy with a Psychologist

Assessment

Parenting Support

Positive Behaviour Support

Social Work

Appointment Type(Required)

Please select how you would like to attend appointments.

Face to Face in clinic

Home Visit

Telehealth

Funding(Required)

Private paying client (no referral)

Mental Health Care Plan - Psychology referrals only (please note we do not bulk-bill)

NDIS Funded

Other (Please Specify)

Funding(Required)

NDIS Funded

Other Funding (Please Specify)(Required)

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NDIS Participant - Required Information

NDIS Participant Number(Required)

Plan Start Date(Required)

Plan End Date(Required)

Plan Mangement Type(Required)

If Plan Managed, please provide plan manager details.(Required)

Please provide NDIS goals (if known)

Supports in Place - Formal

Supports in Place - Informal

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NDIS Participant - Required Information

Is Positive Behaviour Support (PBS) funded in the NDIS plan?(Required)

This will be listed under Improved Relationships.

Yes

If PBS is not currently funded, is a Functional Assessment sought to recommend this support?

Yes

Are restrictive practices sought or in place?

Yes

Is there Child Safety or other government stakeholder involvement?

Yes

Please outline the Child Safety or other government stakeholder involvement below:(Required)

NDIS Participant Details

NDIS Participant Number(Required)

Plan Start Date(Required)

Plan End Date(Required)

Specialist Behavioural Intervention Support

Funded Amount

Hours Allocated

Behaviour Management Plan Incl training in Behaviour Management

Funded Amount

Hours Allocated

NDIS Plan Management Details

Plan Mangement Type(Required)

If Plan Managed, please provide plan manager details.(Required)

Please provide NDIS goals (if known)

Supports in Place - Formal

Supports in Place - Informal

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Treatment Goals/Reason for Referral

What is the main reason for seeing a clinician? Please include any behaviours of concern if applicable.(Required)

What do you hope to get out of therapy?

Why are you seeking help now?

Please provide any other information you think your clinician should know

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Existing Conditions

Please list any existing medical or psychiatric conditions

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Legal Matters

Are there any current or pending legal matters relating to this referral?

Yes

Please briefly describe the legal matter

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Attachments

Please attach any relevant documentation to support your referral.

Attach Files

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 1 MB, Max. files: 10.

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How did you hear about Hively Health?

We acknowledge the Traditional Owners of this land and pay respect to elders past, present and emerging.

At our practice, we proudly embrace and support the LGBTQI+ community and neurodiversity. We believe in providing a safe, inclusive, and affirming space for individuals of all sexual orientations, gender identities, and neurodivergent experiences. We are committed to fostering a therapeutic environment that values diversity, celebrates individuality, and promotes holistic well-being. Your authentic self is always welcome here.