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Veteran Initial Psychiatric Assessment (VIPA) Form

This form is the first part of assessment with Dr Al Griskaitis (psychiatrist).
It is used where either you want:
-> Psychiatric Treatment recommendations
and/or if a
-> DVA mental health condition(s) claim is planned.
Typically both reasons apply.
You will need:
1. Your DVA number,
2. Between 25-50 minutes to complete (depending on your complexity)
Helpful additional info:
3. If you upload your GP referral below you can book in you appointment with Dr Griskaitis at the end of this form, (or you can email the GP referral and book in later if you don't have one yet).
4. If you have DVA accepted conditions then the onset dates (from MyGov) are very helpful.
5. The name and email of your advocate (if you have one).
Note:
The final section will ask about Pain and Stressful Events that might have caused your conditions. Date estimates are okay.

First Name

Last Name

Sex

A
B

DOB

Date of birth

Email

Mobile

Postcode

DVA number

Who suggested you see Dr. Griskaitis?

Name of Usual GP

Employment

Most recent rank

What were your main roles in the Defence Force?

In what year did you join the ADF?

In what year did you leave the ADF ?

Were you medically discharged?

A
B
C

Current employment status (role and pattern)

If you are currently working, what do you do and who do you work for?

Home

Ages of children

Who lives with you?

Why are you doing this?

Dr Al Griskaitis provides a primary care treatment plan after his assessment.
A primary care treatment plan is a plan that your GP carries out.

What are you main treatment priorities (select up to four)

Which four treatment priorities are the most important to address for you?

Are you making a DVA mental health claim/you also require a DVA report?

A
B

Conditions already accepted by DVA

Do you already have conditions accepted by DVA?
-> Refer to MyGov for dates if possible please.
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