Referral Form

This form is designed for website eReferral, PDF referral, Medical Objects referral, or secure email referral. For electronic submissions, completion of referrer details and the declaration below constitutes authorisation by the referring practitioner.

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1. Referrer Details

2. Patient Details

3. Clinical Summary

4. TMS Clinical Screening

5. Referral Authorisation & Privacy


I confirm the patient has consented to this referral and to the release of relevant clinical information to Connected Minds TMS for the purpose of triage, assessment, treatment planning, and communication with treating practitioners involved in their care.

6. Submission Instructions


Please submit via secure website form, Medical Objects by searching "Connected Minds TMS", or secure email to admin@connectedmindstms.com. Our team will contact the patient directly to arrange assessment. Electronic submissions should retain date/time, referrer details, and submitted clinical information as an audit trail.

7. Clinic Use Only