School referral form for Psychology

Psychology services at Down South Therapy provide support for children in managing emotional and behavioural challenges, developing coping skills, and improving their social connections. If you have observed behaviours such as anxiety, difficulties with behaviour management, or social challenges, this form enables you to provide this information. The information you provide serves as the initial step to DST following up your expression of interest for our psychology services, noting the information below.
Please note, you will be required to include contact details for the parent/guardian before submitting this form (Name, Phone, and Email). You will also be asked to confirm that consent has been obtained for this referral. Please ensure you have this information prior to completing the form.

Please note our services may not be suitable in all cases, as our clinicians have specific areas of experience. We are unable to assist with complex trauma/PTSD (including sexual abuse), bipolar disorder, psychosis, eating disorders, substance use issues, crisis needs (such as ongoing safety risks or domestic/family violence), significant family distress affecting child care and ability to attend appointments, or forensic needs. Thank you for understanding.