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To refer a patient to Essendon Private Clinic please complete the form below and return it via fax or email to the Senior Nurse Manager.

MHPFOR 162 Referral Form V

Specialist Accreditation

Essendon Private Clinic encourages Psychiatrists to apply for accreditation to our facility. Please download the following forms:

HWFOR 051 Visiting Practitioner Application for Clinical Privileges V1

HWFOR 052 Visiting Practitioner Guidance on how to obtain 100 points of identification V1 

All applications are subject to review by the Medical Advisory Committee (MAC).

You will be asked to provide:

  • Current Curriculum Vitae
  • Current AHPRA Registration
  • Contact details for 2 referees
  • Current Professional Indemnity Insurance

For further information please contact the Hospital Director.