Request a Mental Health Treatment Plan appointment

The purpose of this form is a once off yearly charge of $55 which allows to cover the cost of communicating with your Psychologist or other Healthcare professional. After payment and if you are eligible under Medicare, your sessions with the nurse practitioner and GP will be bulk-billed.

MHTP step-by-step guide

Request a MHTP appointment (completing this form).
Receive your MHTP and fill out initial details.
Our MHTP team will give you a call to confirm details and organise your first telehealth appointment with a Nurse Practitioner.
You’ll have a virtual bulk-billed consultation with one of our Nurse Practitioner who will go over your initial details.
We’ll schedule your next appointment with a GP, at a time that suits you.
You’ll have your second bulk-billed telehealth appointment with our GP, who will complete your MHTP.
You’ll automatically receive a copy of your MHTP.
We can send your completed MHTP to your preferred psychologist or to our preferred partner (with bulk-billing available!): Talked

Patient details

First Name *

Last Name *

DOB *

Phone Number *

Email Address

Residential Address *

Do you have a Medicare card? *

YesNo

Reason for appointment *

Preferred date and time

Is the appointment for you or your child? *

MyselfMy childOther/Guardian

Consent

In submitting the information contained in this form, I consent to the collection of personal information and Privacy Policy, confirm I have read and acknowledge the Billing Policy, and have read and understood the MHCP FAQs. *

If eligible for Medicare, DVA or concessional billing do you give permission to bill? *

YesNo

If Bulk Billed, I assign my rights to the Healthcare professional who rendered the services. If eligible for a Mixed billed consultation a medicare rebate will be processed and deposited into your nominated bank account directly by Medicare. *

YesNo

Referral

Do you give consent to provide your MHTP to our partner psychology practice (Talked)?

Yes, please send my MHTP directly to Talked.No, I already have a preferred psychologist.I have not made a decision on my psychologist.

Message or Comment

Payment

A once off yearly charge of $55 which allows to cover the cost of communicating with your Psychologist or other Healthcare professional.

Please complete the following payment prior to submitting your form *