PANDA Helpline Services Healthcare Provider Referral Form

This form is for healthcare providers looking to refer a person to the Helpline.

PANDA takes privacy seriously, please read our Privacy Policy for more information.

Service Eligibility

Expecting and new parents with a child up to the age of 12 months are eligible for PANDA Helpline services.

For parents of older children, please contact Parentline in your State or Territory, or the Pregnancy Birth Baby Helpline on 1800 882 436.

Informed Consent

Please ensure your client understands and agrees to being referred to PANDA. This means they know:

What PANDA does — we provide free, confidential support for people experiencing perinatal mental health challenges.
That PANDA will try to contact them by phone via our Helpline.

Once we receive and triage the referral, we will:

Send your client a text message about 5–10 minutes before our first call attempt.
Try calling several times if we don’t reach them initially.
Leave a voicemail if possible.

If it’s not safe for your client to receive calls or voicemails, we recommend they contact PANDA directly on 1300 726 306 at a time that suits them.

Information to Support Referral

To help PANDA connect your client with the most appropriate support, please provide as much relevant information as possible. This helps our team triage effectively and tailor our response to your client’s needs.

Our approach is guided by PANDA’s Model of Care, which prioritises safety, choice, and culturally responsive, trauma-informed support. The more context you can share — including presenting concerns, risk factors, support needs, and any known preferences — the better we can ensure your client receives the right care at the right time.

Eligibility

Your client is...

Due date:

Delivery date

Referral details, icluding risks or safety plans

Please specify any mental health care support your client is receiving, as well as any other relevant referrals made

Mark N/A if not applicable

Mental health or wellbeing screening results (e.g. EPDS, DASS, MARAM, or other assessments)

Include any relevant scores, dates or notes from recent mental health or wellbeing assessments.

If you have completed any screening tools (K10, EPDS) or have prepared a treatment plan you wish to share with PANDA please upload here.

Health Care Provider Details

Please provide your contact details and role. This helps PANDA understand who is referring into our service and supports service planning, engagement, and continuous improvement.

We may not always be able to contact you to confirm the outcome of the referral. However, we will attempt to contact your client several times via our Helpline. If it’s safe, we’ll send a text message shortly before calling and may leave a voicemail.

Important: PANDA is not a crisis service. If your client is experiencing significant or immediate risk, please ensure they are supported through appropriate emergency or acute care pathways. PANDA does not provide immediate contact or crisis intervention.

Title

First Name

Last Name

Referring Practice / Organisation

Practice / Organisation Type

Mobile

Phone

State

Email

I have discussed this referral with my client and I am satisfied they understand why information is being shared with PANDA and for what purpose.

I confirm this referral has been discussed with my client/patient and informed consent received.

I have explained to my client that PANDA will contact them via the supplied phone number and my client has consented to be contacted by PANDA.

I confirm my client/patient consents to being contacted by PANDA.