www.sydneyhypno.com.au - Medical Referral Form

Hello & thank you for taking the time to refer your client to us for ancillary support, we are here to support you and your client with our support services.

SydneyHypno's Kerry Bailey works extensively with Medical Professionals as an Allied Health provider to support the wellbeing of the wider community.

Kerry uses a client centered, therapist lead approach to ensure your clients will be seen, heard, and regarded as much more than their illness or disability.

Our services include and extend beyond counselling, as we undertake a strategic approach to assist individuals to develop new cognitive and emotional skills and capacities, to move beyond their current circumstances.

Services

Gut Directed Hypnotherapy, Sleep Support and divers sleep related issues, Medical Anxiety, Dental Anxiety, Phobias & Irrational Fears, Diabetic Non-compliance and other issues (helping with a GP's or Specialists treatment compliance) and much more including Smoking Cessation, Addiction Management and other distresses that the Clients of the Medical Professions report. Our role is to support the medical professiona to get the outcomes that thye want for their patients, by supporting alongside the mdeical Strategic psychotherapy, clinical hypnotherapy, EFT, NLP, EMDR, And other modalities counselling, and behavioural analysis.

How to Refer to us

We currently do not have long waiting lists, and you can expect your client to be seen in 1-2 weeks from referral.

we have a good rate of clients clearance rates, as many clients only need to see Kerry at SydneyHypno, less than 6 times to get clear of many obstacles that have been holding them back from reaching the goals that you their medical professional have been wanting to find they could move past.

In general, we get to spend at least 50 to 60 mins per session with your clients and use a multidisciplinary modality approach to assist them to get clear of the previously ongoing concerns and issues the clients often reported.

NDIS Fees and Rebates

Currently unavailable ( for plan managed and self managed plans.)

Accessibility:

Telehealth services for ease and accessibility.

This allows us to see clients virtually anywhere and helps us to keep our fees low.

Privacy: Please - Only send referral appropriate information or the referral form .

Clients who choose to engage further with SydneyHypno services will be required to complete a Client Intake Form which will be handled with appropriate mandated confidentiality.

Feel free to contact Kerry Bailey directly on 0412-412-881 or via email : kerry@sydneyhypno.com.au - if you prefer to chat first.

Client Information

Client Full Name (Answer required)

Referrer - Clinic, Surgery, Specialist - (Answer required)

Referrer - Which medical professional is the direct referrer (Answer required)

Referrer contact number (Inc area codes please) (Answer required)

Numbers only

Referrer Email (Answer required)

Address of Referrer in Full

Full Address please, Street #, Street Name , Suburb, State & Country

Preferred time & phone number etc - to be contacted (to discuss the clients needs or other matters related to the referral

this allows us to call to discuss the clients needs

Are you currently the referred clients health care provider?

GP (General Practitioner)Therapist (Please nominate all in space provided)Specialist (please nominate all in space provided)

Per above- If you have details other than already shared please advise any added details as to the relationship here please:

If you wish to relay any specific details as to what I should know as as is diagnosed (details here)

If you wish to advise details about why you have referred this client to us, or to advise other medical services providers associated with this clients care - please advise here

PHYSICAL/MEDICAL CONDITIONS - Advise to refers about SydneyHypno Practices:

Clients made are aware of the following:

If your presenting issue manifests with physical symptoms, we cannot treat you unless you can show us that you have been cleared of any underlying physical issues. Problems like constant headaches or migraines, back and neck pain, tinnitus, irritable bowel syndrome, psoriasis, alopecia, bedwetting, allergies, eczema, weight loss, restless leg, immune system deficiencies, cancer and alike must first be checked with a medical professional, and a medical reason for the issue has been discounted before we can treat you ethically.

N.B. Sometimes people’s philosophies about the root cause of an issue can preclude investigating appropriate answers to the issues. For some people everything has an emotional root. We are not of this opinion, and such extreme views can be harmful.

This caveat is demanded out of our duty of care. For example, we want to know that headaches are not a symptom of a larger more serious issue that will be ignored if we help you minimize the discomfort. We will want to see evidence of your medical history and may wish to speak to your doctor about your treatment options. Our preference is that we see you with your GP’s knowledge and cooperation.

MEDICAL DISCLOSURE

I have pursued all reasonable medical avenues to deal with the presenting issue, and have been informed by my medical practitioner that it is not physical but a psychosomatic issue, or alternatively, it is a physical issue but there is nothing more the medical system can do for me. I also agree to provide any relevant Mental Health Care Plans to SydneyHypno as appropriate including but not limited to Mental Health Safety Plans to ensure my plans can be integrated for my best health and safety.

(Answer required)

I have read this

JURISDICTION

This agreement and this website and forms are subject to the laws of NSW and Australia. If there is a dispute between you and www.sydneyhypno.com.au that results in litigation then you must submit to the jurisdiction of the courts of NSW. (Note that the link to the Australian Govt - Schedule 3 Code of Conduct - for non-registered health practitioners is provided for you to understand the bounds of this treatment :

https://www.health.nsw.gov.au/phact/Documents/coc-unregistered-practitioners.pdf

read

Dated:

www.SydneyHypno.com.au (ABN 34 137 510 751) Kerry Bailey m: 0412-412-881

Contact Information