Request for consultation

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:


    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


    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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