Make a Referral

Online referral for instructing parties.

Send us a referral through our fully secure and encrypted online referral form. You’ll receive a confirmation email with the details you submit. We aim to respond in 1 working day.

    Injured Person’s Details:

    Referrer (Your) Details:

    Are you the funding party*?

    [group FundingParty]

    Funding Party Details:

    [/group]

    Are you the claimant’s legal representative?*

    [group RepresentativeDetails]

    Claimant Representative Details:

    [/group]

    [group Representative]


    [/group]

    Select a Service:

    Treatment Only

    Treatment Only: Facilitation of a documented medicolegal or other clinical recommendation for treatment, consultations, surgery or diagnostics.

    [group group-required-treatment]

    What type of treatment do you require? E.g. physiotherapy, psychology etc*


    [/group]

    Triage

    Triage: Rehab Code compliant triage assessment and treatment for minor MSK injuries.

    Desktop Immediate Needs Assessment (INA)

    Desktop Immediate Needs Assessment (INA): A remote based desktop assessment that provides a fully costed rehabilitation plan and MDT treatment approach for moderately complex injuries and / or those requiring support with a return to vocation.

    Multitrack Immediate Needs Assessment (INA)

    Multitrack Immediate Needs Assessment (INA): An in-person assessment that provides a fully costed rehabilitation plan and MDT treatment approach for complex injuries and / or those requiring support with a return to vocation.

    Catastrophic Immediate Needs Assessment (INA)

    Catastrophic Immediate Needs Assessment (INA): An in-person assessment that provides a fully costed rehabilitation plan and MDT treatment approach for life changing injuries – ABI, spinal cord, major limb amputation, paediatrics.

    I’m not sure, please call me to discuss

    Please call me to discuss.

    Additional instructions or documents: