Private Health Referral

The Paragon PsychConnect Team has psychologists and counsellors that can work with you to assist in developing strategies to manage pain, chronic disease, and various psychological conditions both individually, or in a group program.


Once you complete and submit the Private Health Referral form, the completed form will be sent to us, and emailed to you.

We will then contact you to discuss your needs.


Alternatively, if you cannot complete the online form below:

  • Or you can contact us by submitting an enquiry and we will contact you as soon as possible.


Please note:

  • The required fields in the form below are marked with a red asterisk *.
  • If you cannot complete the form, an email will be sent to you after a time, with a web link to finish the form if you wish.  The Client First Name and Client Email Address must be entered for this to work.
Referral Form Private Health
  • Client Details
  • Submit Form

Private Health Referral Form

Client Details

Client Title
Client Address *
Client Address