Psychologist & Well-Being Support Referral Form

We offer up to four appointments per semester with our MADALAH Psychologist to support your social and emotional well-being and access to ongoing external services. Our Psychologist will review if further ongoing appointments will be required and you will be advised of this outcome.

Appointments are available fortnightly on a Thursday between the hours of 8:15am and 4:30pm for current Tertiary Scholars.

If these times are not suitable, please let us know and we will do our best to accommodate.

Email: or call/text 0461 314 402

Appointments will be telephone consults unless requested otherwise. 

Student Details

Student Name(Required)

Consent for Support

Do you consent for our Psychologist to contact you?(Required)
Please be aware that failure to reschedule in advance or no answer on the day of your appointment may impact the availability of future appointments.(Required)

Acknowledgement of Country

MADALAH acknowledges and pays tribute to the Whadjuk Noongar, the Traditional Custodians of the Lands on which we work, and we pay our respects to their Elders – past, present and emerging. This acknowledgement extends to the First Peoples’ land across the state of Western Australia which is home to the many students that we support.

MADALAH recognises and values the continuity of cultural, educational and spiritual practices of First Peoples.

We wish to advise our First Peoples that this site may contain the names, images or audio-visual recordings of people who have passed.