Aims This study evaluated the implementation, uptake, and preliminary outcomes of a novel, embedded psychological prehabilitation pathway for patients undergoing major HNC surgery at an Australian tertiary hospital. Methods A retrospective audit was conducted of all adult HNC patients referred to the psychological prehabilitation pathway between October 2024 and September 2025. The model of care included routine pre-surgical psychological screening and assessment, targeted intervention where indicated, and follow-up at 4 weeks and 6 months post-operatively. Extracted data included referral outcomes, service utilisation, patient-reported measures of anxiety, depression, and coping. Results Eighty-six patients were eligible for the pathway; 62 (72%) accepted referral and 24 (28%) declined. Of those who accepted referral, patients were 61% male with a mean age of 59 years (SD=17, range 27-88). Nearly half (48%) resided regionally and 70% were born in Australia. The period between referral and surgery was on average 30.2 days (n=58, SD=28.7, range =1-160). The mean number of appointments attended was 4.19 (SD= 3.81 range = 1– 21). Average scores on baseline screening indicated mild levels of anxiety and depressive symptoms and moderate coping. At 1- and 6-months follow-up, mean anxiety and depression were in the normal range and increased coping was reported. Common presenting concerns included fear of speech and swallowing dysfunction, body image disturbance, and anticipated loss of identity following surgery. Conclusions Early implementation of a psychological prehabilitation pathway within HNC surgical care suggests it can be delivered in routine practice. The model showed strong uptake and addressed key psychosocial concerns during a critical phase of the surgical trajectory.