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SelfReferral Form Massey University Psychology Clinic PN319 Massey University Private Bag 11222 Palmerston North Phone (06) 350 5196Email to: massey.clinic.pn@massey.ac.nz Date of Referral Client
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How to fill out fax to psychology clinic

01
Start by addressing the fax to the psychology clinic's fax number.
02
Include your name, contact information, and any relevant patient information in the header of the fax.
03
Clearly state the reason for the fax, whether it is a referral, follow-up information, or other correspondence.
04
Provide any necessary medical records, test results, or additional documentation to support the information being faxed.
05
Double check all information for accuracy before sending the fax to the psychology clinic.

Who needs fax to psychology clinic?

01
Patients who need to provide medical information or documents to their psychologist or therapist.
02
Medical professionals who need to refer a patient to a psychology clinic for evaluation or treatment.
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Fax to psychology clinic is a form of communication used to send important documents, reports, or information to the psychology clinic.
Healthcare providers, therapists, counselors, or anyone involved in the patient's treatment may be required to file a fax to the psychology clinic.
Fax to psychology clinic should be filled out with the patient's name, contact information, reason for referral, any relevant medical history, and the sender's contact information.
The purpose of fax to psychology clinic is to provide necessary information about the patient's condition, treatment, or progress to the psychology clinic for further evaluation or treatment.
Information such as patient's name, date of birth, contact information, reason for referral, medical history, diagnostic tests, and treatment plan must be reported on fax to psychology clinic.
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