Request for consultation

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Request for consultation

Before proceeding with your request please ensure you read and can agree with the following privacy and clinical responsibility positions regarding case consultations.

Your Information

Please ensure you only include de-identified client information

Consultee Name:

Position:

Service name:

Contact phone number:

Contact email address:

Your Professional Group / Discipline:

Your place of employment:

Area Mental Health Service

Other health / welfare service

Service setting


Client Information

Diagnosis

Check box - multiple options allowed (required field)

Eating Disorder:

Co-Occurring Diagnoses:

Briefly outline the following
Care Team

Client’s clinical presentation

Client's family background & structure

Client's social, school / work history & current circumstances

Mental health formulation & treatment approach

Consultation support / help sought


Accept terms and conditions

You will receive an automated response confirming your form has been submitted. You will receive a further email within the next 48hrs confirming CEED has received your request. A CEED clinician will make contact following allocation.

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