Request for psychological services.

This form is for school wellbeing staff and student support coordinators referring a student for psychological assessment. It is a briefing, not a clinical intake — enough for Aley to understand who the student is and what the school is seeing.

Aley will review this referral and contact the parent or guardian directly to arrange an intake interview. Initial contact is usually made within five business days.

Families seeking an assessment for their own child don't need this form — use the contact page instead. If you'd rather talk it through before referring, call 0403 300 022 or email aley@mantuapsychology.com.au.

1. 01

   You lodge the referral

   The form below goes straight to Aley. You get a reference number on screen and a short confirmation by email — no student details in it, since school inboxes are often shared.

2. 02

   Aley reviews it

   She reads the presenting concerns and the interventions already in place, and works out whether an assessment is the right next step or whether something else would serve the student better.

3. 03

   The family is contacted directly

   Aley contacts the parent or guardian to arrange an intake interview. From that point the referral belongs to the family, and scope and fees are agreed with them.