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A mental health referral letter is a signed, dated request from one clinician to another to assess or treat a named client. It states the referral question, relevant history, current medications, symptoms and measures, risk status, and what the referrer keeps doing while care continues. GPs, therapists, psychologists, and psychiatrists exchange them whenever care crosses providers. Most run 150 to 500 words.
Any referring clinician: GPs, primary care physicians, therapists, psychologists, psychiatrists, NPs
The receiving provider; the client's record on both ends; payers when a rebate or claim depends on it
150 to 500 words · 10 to 20 minutes by hand (clinical team estimate)
Clinical correspondence (compare: consultation report, transfer-of-care summary)
When you ask another provider to assess or treat a client while your own care continues
Naming and service systems vary by country; only Australia's Better Access prescribes the content by law
A mental health referral letter is a written, signed, dated request from one clinician to another to assess or treat a named client: a GP asking a psychologist to provide therapy, a therapist asking a psychiatrist to evaluate for medication, a psychiatrist directing a patient into a specialist program. It carries the clinical information the receiving provider needs in order to say yes, and in payer-linked systems it is the document that makes the resulting care billable. Nobody invented it; it is a professional convention that each country's payer has formalized differently, most fully in Australia, where the Better Access initiative made the referral a condition of Medicare rebates in 2006. You will also hear it called a referral, a GP referral, a letter of referral, a consult request, or, in newer Australian templates, a request for services letter.
Get the letter's status right, because it points in opposite directions in different countries. In the United States, no referral is generally required for outpatient therapy: under Original Medicare, clinical psychologists, clinical social workers, and, since January 1, 2024, marriage and family therapists and mental health counselors treat without a physician referral or order (42 CFR 410.71 and 410.73); where a referral requirement exists, it is a Medicare Advantage or commercial-plan contract term, not law. In Australia the letter is load-bearing: a valid signed, dated referral is a precondition of every Better Access rebate, and the GP mental health treatment plan is expressly not a referral, so a practice that sends the plan without the letter has referred nobody. Canada sits between: provincial plans pay for psychiatry on a physician or nurse practitioner referral, while private therapy needs none. There is, in short, no single standard format. Only Australia prescribes the content by law; everywhere else the letter is judged by whether the receiving clinician can act on it.
Referral letters move in every direction across mental health care: GPs and primary care physicians refer into therapy and psychiatry (in Australia, the only route to a rebated psychology session), therapists and counselors refer clients to psychiatrists for medication evaluation, psychologists refer for testing, psychiatrists and paediatricians refer directly into Better Access, and nurse practitioners refer for consultations in Canada. Reach for a referral letter when you are asking another provider to take on a defined task while your own care continues. When you are ending your role and handing over responsibility, write a transfer-of-care summary instead; when an inpatient or program episode closes, the discharge summary does the handing off; and the specialist's written answer to your question is its own document type, covered on the psychiatric consultation note page.
Header, addressee, and identifiers. Date, your name, credentials, and practice details (in Australia the prescribed particulars are your name, your practice address or provider number, and the date; for US plan-required referrals, the NPI that will go on the claim), then the client's name, date of birth, and contact details, all three required on a Better Access referral. Address it to a named clinician, a practice, or simply "Dear colleague." Pitfall: assuming the letter must name a specific clinician. Australia expressly allows a generic address, and the client may take the referral to any eligible professional of the same discipline; Ontario accepts a clinic name when the consultant is unknown.
Referral question. One or two sentences, placed first: what you are asking the receiver to do (assess and advise, evaluate for medication, deliver a course of therapy), for whom, and why now. Everything else in the letter exists to serve this sentence. Pitfall: "please assess" with no answerable question. Incomplete referrals are the main reason letters bounce; one audit cited in the referral-quality literature found more than 40% of referrals to specialist mental health services were not accepted.
Relevant history and medications. Working diagnosis or impression, treatment to date and response, prior episodes, relevant medical history, and current medications with doses. Select for relevance: include what would change the receiver's decision, leave out the rest. Pitfall: omitting the medication list. It is one of the content fields a Better Access referral must include, and for a medication-evaluation referral it is the first thing the psychiatrist looks for.
Current symptoms and measures. The presentation now, with dated scores where you have them (PHQ-9, GAD-7, K10, DASS-21) and the functional impact on work, study, or relationships. Australia requires the symptoms or diagnosis to be stated. Pitfall: severity carried by adjectives alone. "Significant distress" gives the receiving clinician nothing to triage on or retest against; a dated score does both.
Risk status. One explicit line either way, with when you last assessed it. Pitfall: silence on risk. The receiving service sets urgency from this line, and a letter that never mentions risk forces them to assume it was not assessed and to re-triage from nothing.
Your ongoing role. State what continues with you: session frequency, what you will keep working on, who the client contacts between appointments, and how you want to coordinate. Pitfall: leaving your role unstated. A referral hands over a defined task while care continues with you; a letter that never says so reads as a transfer of care, and the receiver may assume they now hold the whole case.
Urgency, sessions, attachments, and signature. Mark the priority and any timeframe, state the number of sessions requested (in Australia, a referral that does not specify a number is taken as six), whether an MHTP or PAMP has been prepared, and what is attached; then sign and date it, on paper or electronically. Pitfall: an unsigned or undated letter. Signature and date are conditions of a valid Australian referral, and a plan-required US referral missing the referring provider's identifier denies with CARC 183 or RARC N286.
MENTAL HEALTH REFERRAL LETTER
Date: __________ Priority: [ ] routine [ ] urgent, needed by: ________
From: ____________________________ Credentials: ________________________
Practice address / provider no. (AU) / NPI (US plan referrals): _________
To: _____________________________________________________________________
(a named clinician, a practice, or "Dear colleague")
Client: ____________________ DOB: __________ Phone: ___________________
Address: ________________________________________________________________
REFERRAL QUESTION (what you are asking the receiver to do, and why now)
_________________________________________________________________________
RELEVANT HISTORY (working diagnosis, treatment to date and response,
relevant medical history)
_________________________________________________________________________
CURRENT MEDICATIONS, WITH DOSES (required on Better Access referrals)
_________________________________________________________________________
CURRENT SYMPTOMS AND MEASURES (dated scores: PHQ-9, GAD-7, K10, DASS-21)
_________________________________________________________________________
RISK STATUS (state it either way, with the date last assessed)
_________________________________________________________________________
MY ONGOING ROLE (what continues with you; contact between appointments)
_________________________________________________________________________
Sessions requested (AU: six assumed if unspecified): ____________________
MHTP or PAMP prepared? [ ] yes, date: ________ [ ] no [ ] n/a
Attachments: [ ] release/consent [ ] treatment plan [ ] score log
[ ] other: _________________________________________________
Report back requested: [ ] after assessment [ ] end of course
Signature (electronic accepted in AU and US): ___________________________
Name / credentials: ______________________ Date signed: ________________Free to use and share, no signup. The PDF includes a one-page cheat sheet with section-by-section pitfalls and a pre-sign checklist; the DOCX is the blank template, ready to adapt.
Scenario: a therapist in US private practice refers an adult client with recurrent depression to a psychiatrist for a medication evaluation while weekly therapy continues. All details are fictional.
Mental Health Referral Letter. From: S. Okafor, LCSW, Riverbend Counseling Group · To: A. Meloni, MD (psychiatry) · Date: 08/04/2026 · Re: D.R., DOB 05/14/1997
Dear Dr. Meloni,
Referral question: I am referring D.R., a 29-year-old client in weekly cognitive behavioral therapy with me since March 2026, for psychiatric evaluation of recurrent major depressive disorder and a recommendation on pharmacotherapy. Please assess whether medication is indicated, and either initiate and manage prescribing or advise me and her primary care physician. Routine priority; she can attend weekday afternoons.
History: First depressive episode at age 22, resolved without treatment. The current episode began in January 2026 after a job loss. Fourteen weekly CBT sessions since 03/09/2026 (behavioral activation, cognitive restructuring) produced early gains that have plateaued over the past six weeks. No prior psychotropic trials, no hospitalizations, no history of mania or psychosis. Medical history: hypothyroidism, stable on levothyroxine 50 mcg daily; TSH in range 05/2026 per PCP labs. No other medications, no known drug allergies. AUDIT-C 2 at intake; she reports no current alcohol or drug concerns.
Current presentation: PHQ-9 on 08/03/2026: 14 (moderate), down from 19 at intake and stable between 13 and 15 across the last six weekly administrations. Persistent early waking, low energy, and reduced concentration affecting work performance. GAD-7: 6.
Risk: D.R. denies suicidal ideation, plan, and intent, screened at every session including 08/03/2026; no history of self-harm. I assess current risk as low and review it weekly.
Ongoing care: I will continue weekly CBT and remain her primary mental health contact between appointments. I am asking for evaluation and medication management, not a transfer of care. I would appreciate a copy of your consultation report and am glad to discuss by phone.
Attachments: signed release of information, current treatment plan, PHQ-9 and GAD-7 score log.
Thank you for seeing her.
Sincerely,
S. Okafor, LCSW (license 12847)
Riverbend Counseling Group · (555) 014-2276 · signed electronically 08/04/2026
This sample is fictional and for educational purposes. It does not describe a real patient.
Writing these after every session? BastionGPT drafts complete notes from bullets, dictation, or a transcript.
Generate a note from bulletsA referral letter is ordinary clinical correspondence, which means it lives in the record twice: your copy in the sending chart, the receiver's copy in theirs, both part of the record set the client can request and read. Write it accordingly. Because the letter carries clinical content to another practice, settle consent before it travels: the clean practice in any jurisdiction is a documented consent conversation, and a signed release of information when records travel with it. Retention follows the strictest rule that applies to you rather than any referral-specific one. In the US, HIPAA's six-year rule covers required documentation while state law governs charts, and Medicare providers are generally advised to keep records 7 to 10 years. Ontario's regulated professions generally keep records 10 years from last contact, or from the age of majority for minors. NSW, Victoria, and the ACT require 7 years from the last entry for adults and until age 25 for minors, and Australian Medicare separately requires documents an MBS item creates, referrals included, to be kept for 2 years under the Health Insurance Act 1973. On the receiving side, an Australian professional must hold the referral at the first consultation for the rebate to stand.
The payer layer is where the three countries split. No US or Canadian regulator publishes an element list for a mental health referral letter; the format is convention, and what is regulated is the billing that hangs on it. Under Original Medicare a referral functions as an exemption rather than a prerequisite: a clinical psychologist or clinical social worker who bills Part B must offer, with the client's consent, to consult the client's physician, unless that physician referred the client, which waives the duty (42 CFR 410.73; 42 CFR 410.71(e)), and neither party may bill for that consultation. The genuine US requirements are narrower: psychological and neuropsychological testing by an independently practicing psychologist needs a physician order, and Medicare Advantage plans (42 CFR 422.112 permits referral gates) and commercial plans may require referrals by contract, in which case the claim carries the referring provider's NPI or denies with CARC 183 or RARC N286. In Ontario, a consultation is billable only on a written request naming the referring physician or nurse practitioner and carrying their OHIP billing number under section 38.4 of Regulation 552; without it, the service pays as a lesser assessment. In Australia the letter is the rebate instrument itself: the plan is not a referral, the psychologist must hold the letter at the first consult, and the loop closes with a written report to the referrer after each course of treatment, the clinician-to-clinician reply covered on the consultation report page.
The referral letter occupies an odd place in the audit record: in the US it is rarely the document that costs money. The OIG's national psychotherapy audit (A-09-21-03021, 2023) estimated that $580 million of roughly $1 billion in Medicare psychotherapy payments from March 2020 to February 2021 was improper, and the defects sat in the psychotherapy documentation itself: missing start and stop times, treatment plans, and evidence of the service furnished, not referral letters. Where the referral does bite is at the claim edge and abroad. US plan-required referrals deny with CARC 183 (referrer not eligible to refer) or RARC N286 (missing or invalid referring-provider identifier). Ontario rejects claims with codes AC4, ARF, or ERF when the referring OHIP number is missing or the referrer ineligible, and pays the consultation as a lesser assessment without a valid written request. Australia's Professional Services Review keeps finding mental health plans and referrals that cannot be located for the date of service; a case in the PSR Director's July 2025 update ended in repayment and disqualification from a range of MBS items. The referral-quality literature adds the clinical cost: audits of referrals into specialist mental health care repeatedly find them incomplete, one cited audit reporting more than 40% not accepted. The BastionGPT Clinical Advisory Board sees the same errors most often in referral letter reviews:
| Aspect | United States | Canada | Australia |
|---|---|---|---|
| Status | Direct access is the default: Original Medicare requires no referral for therapy by psychologists, clinical social workers, MFTs, or MHCs; Medicare Advantage and commercial plans may require one by contract | Provincial plans pay for psychiatry on a physician or NP referral; private therapy, psychology, and social work need no referral (self-pay or private insurance) | A valid written, signed, dated referral is a precondition of every Better Access rebate, set by the section 3C Determination and MBS notes; e-signatures are acceptable |
| Terminology | Referral; referring or ordering provider | Referral, consultation request, written request | Referral, GP referral, request for services letter |
| What changes | Plan type decides everything: when a plan requires a referral, the claim carries the referring provider's NPI or denies (CARC 183, RARC N286); a physician referral also waives the psychologist's offer-to-consult duty | In Ontario, a consultation is billable only on a written request carrying the referrer's OHIP billing number; without it the service downgrades to a lesser assessment | The referral must state symptoms or diagnosis, current medications, session count, and whether an MHTP or PAMP exists; from 1 November 2025, MHTP referrals sit with the MyMedicare or usual GP |
| Retention | No federal chart rule; HIPAA's 6-year rule covers required documentation, state law governs records, and Medicare providers are generally advised to keep 7 to 10 years | Provincial; Ontario's regulated professions generally keep 10 years from last contact, or from the age of majority for minors | NSW, Victoria, and the ACT require 7 years from last entry (to age 25 for minors); Medicare separately requires referral documents kept 2 years under the Health Insurance Act 1973 |
The letter itself is portable; what changes across borders is who must write it, what it must contain, and what payment hangs on it. A US or Canadian clinician can adopt the Australian content list wholesale and lose nothing: it is simply a complete referral letter.
BastionGPT is specifically trained, tuned, and clinically tested on referral letters.
See how clinicians use it day to day on the AI therapy notes page.
Many BastionGPT users report saving more than 90 minutes per day on documentation.
HIPAA-compliant with a signed BAA on every plan. Your data is never used to train models. BastionGPT drafts, you review and sign.
Most run 150 to 500 words, a single page. No US, Canadian, or Australian rule sets a minimum or maximum length, requires letterhead, or mandates a coding system on the letter itself; Australia's Better Access rules are about content (symptoms or diagnosis, medications, session count, an MHTP statement), not length. A letter the receiver can read in two minutes, with an answerable question in the first paragraph, beats a chart export every time.
Under Original Medicare, no. Clinical psychologists, clinical social workers, and, since January 1, 2024, marriage and family therapists and mental health counselors furnish outpatient mental health services without a physician referral or order. A referral changes one thing: it waives the psychologist's or social worker's duty to offer to consult the client's physician. The genuine requirements live elsewhere: physician orders for testing by independently practicing psychologists, and Medicare Advantage or commercial plan contracts, which may require a referral and a referring NPI on the claim.
No, and this is the most consequential mix-up in Australian practice. The MHTP is the GP's assessment and planning document; the referral is a separate signed, dated letter, and Medicare pays no Better Access rebate without it. GPMHSC and the Department of Health state plainly that the plan is not a referral, and the psychologist must hold the referral at the first consultation. The referral must come from a GP or prescribed medical practitioner managing the client under the plan, a psychiatrist under an assessment and management plan, or directly from a psychiatrist or paediatrician. The plan side is covered on the Better Access treatment plan page.
If the referral does not specify a number, the psychologist may assume six. An initial course is up to six individual services, and the yearly cap is 10 individual and 10 group. The referral does not expire at calendar-year end: unused sessions carry into the new year and count against that year's cap, despite the annual-expiry claim on many template sites. A new referral is needed for each further course, after the psychologist has reported back and the GP has assessed the need. AN.15.6 even includes a lost-referral provision: the service can proceed on a lost, stolen, or destroyed referral, with "lost referral" recorded in place of the particulars.
No jurisdiction requires it. An Australian referral may be addressed generically, and the client may take it to any eligible professional of the same discipline; Ontario's Ministry accepts naming a clinic when the individual consultant is unknown. What causes denials is not the addressee but the referrer's own side of the letter: a missing signature, date, provider number, NPI, or OHIP billing number, depending on the country.
A referral asks a question and hands a defined task to another provider while your care continues: you keep the client, and the receiver reports back to you. A transfer-of-care summary ends your role and passes ongoing responsibility to the next clinician. The distinction has payer consequences: a transfer does not set off Australia's report-back loop or Ontario's consultation payment rules. If your letter never says you are continuing care, it reads as a transfer.
Often, yes. In Ontario, the consultant must send written findings, opinions, and recommendations to the referrer, and keep a copy of the request, to bill a consultation. In Australia, the treating professional must give the referrer a written report after each course of treatment; no approved form exists. In the US nothing attaches to the referral itself, though the 2025 codes G0546 to G0551 mirror CPT 99446 to 99452 and pay for some clinician-to-clinician consults where the consulting practitioner cannot bill an E/M visit. The reply is its own document type: see the consultation report and psychiatric consultation note.
In Australia, yes: MBS note AN.15.6 cites the Electronic Transactions Act 1999, so an electronically signed Better Access referral is valid. In the US, electronic signatures are generally acceptable under CMS signature guidance. What no jurisdiction excuses is the absence of a signature and date: both are prescribed particulars of an Australian referral, and the treating professional must hold the signed letter by the first consultation.
Yes. Give it a few bullets, a dictation, or the relevant chart notes and it drafts the letter with the referral question up front, then history, medications, measures, risk status, and your ongoing role. It can also produce a plain-language version for the client and check the jurisdiction fields before you sign. BastionGPT is HIPAA-compliant with a signed BAA on every plan, and your data is never used to train models.
Educational content, not legal or billing advice. Sample notes are fictional. Follow your organization's policies and your board, payer, and jurisdiction requirements.