Novel Treatment Program Referral Form

Novel Treatment Program Referral Form

Patient Information

Medical Diagnosis

Alcohol or drug misuse
Concussion
Cardiovascular condition
Chronic pain
Glaucoma
Hallucinations/dissociation
Head injury/neurological disorder
Hepatic disease
Hypertension
Kidney problems
Past Ketamine use
Urinary or bladder condition

GP Information

Referring Doctor Declaration

QueenslandTMS novel treatment program is medically supervised, but all patients must have their own Psychiatrist or GP who continues to provide primary care during the course of novel treatment.

We strive to inspire and support our clients in achieving transformative change, which we believe will ripple out to positively impact society and encourage similar transformations in others.

Contact Us

P: 07 4019 7791
F: 07 4019 7792

Office Hours

Mon-Fri 7:30am - 4pm
Christmas Closure dates: We will be closed on the 22/12/2025 and will reopen on the 05/01/2026

Clinic Location

149 Martyn Street,
Parramatta Park, QLD 4870

General Enquiries

admin@daintreeclinic.com.au

Get in touch with us

Contact Us Cairns

We strive to inspire and support our clients in achieving transformative change, which we believe will ripple out to positively impact society and encourage similar transformations in others.

Cairns

Contact Us

P: 1300 000 135
F: 07 4019 7792

Clinic Location

149 Martyn Street,
Parramatta Park, QLD 4870

Office Hours

Mon-Fri 7:30am - 4pm

Mareeba

Contact Us

P: 1300 000 135
F: 07 4019 7792

Clinic Location

166 Byrnes Street,
Mareeba QLD 4880

Office Hours

Mon-Fri 8:15am - 12.15pm

Townsville

Contact Us

P: 1300 000 135
F: 07 4019 7792

Clinic Location

4/36 Fulham Road,
Pimlico QLD 4812

Office Hours

Mon-Fri 8.30 - 12pm

Brisbane

Contact Us

P: 1300 000 135
F: 07 4019 7792

Clinic Location

Intensive Trauma Treatment Centre, 201/6 Babarra Street,
Stafford QLD 4053

Office Hours

Mon-Fri 8.30am - 4pm