GP Referral Forms

The Midwife Check-in is a free and confidential telephone-based support program for pregnant women and new mums in Queensland. The goal of the program is to reduce the overall incidence of anxiety and depression

This program:

  • Complements the care given by primary care providers
  • Supports patient responsibility and self-care
  • Encourages discussion of topics including mood changes, what to expect, relationships and sex, and feeding and sleeping
  • Supports the emotional health and wellbeing of pregnant women and new mums.

How to Refer

Complete the form online or use one of the software referral templates.

Referral Templates

We have the following Midwife Check-in referral forms available:

  • Genie
  • Medical Director
  • Best Practice 
  • ZedMed
  • Practix.

Please email us advising us which form you require and we will send you a copy.

Instructions on how to import the templates.

Contact Us

For more information, phone (07) 3216 0976 or contact us via email.

Last Updated: 19 January 2017

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