Refer - ORS Group

Services that work

Choose the team with almost 30 years experience in Allied Health, Workplace Rehabilitation, and Disability Services!

Referral Form

Thank you for your interest in ORS Group services.

Please select one of the below options to either complete a referral form or to send an enquiry to request one of our team contact you.

ORS receives referral forms with the understanding that the referrer has obtained client consent to send to ORS for actioning.

Step 1 of 2

Please select one of the following services*
- National Disability Insurance Scheme (NDIS)
- Private Allied Health Services
- Workplace Rehabilitation
- Psychological Services
- General Enquiry

National Disability Insurance Scheme (NDIS):
Workplace Rehabilitation:
Psychological Services:
Workplace Rehabilitation
Worker Details
Worker Name*
Date of birth
DD slash MM slash YYYY
Gender
Interpreter Required
Language
Phone
Mobile
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Claim Details (if applicable)
Claim Number
Date of Injury
MM slash DD slash YYYY
Nature of Injury
Insurance Details (if applicable)
Insurance Company
Name
Phone
Email
Purpose of Referral
Select
Other
Referred by (if referred by insurer, write “Insurer”)
Name
First Last
Company Name
Phone
Email
Select
- Employer
- Injured Worker
- Treating Doctor
- Treating Provider
Other
Please comment if referral for specific services or for assistance with compensation claim
National Disability Insurance Scheme (NDIS) Referral Form
Client information:
Date of referral*
DD slash MM slash YYYY
Customer full name*
NDIS number*
NDIS Plan - start date*
DD slash MM slash YYYY
NDIS Plan - end date*
DD slash MM slash YYYY
Date of Birth*
DD slash MM slash YYYY
Gender*
Address*
Street Address Suburb State Post Code
Telephone*
Email*
Residence type:*
Other*
Customer origin*
Interpreter required*
Please specify language requirements
Does the client have any communication needs or requirements?*
Please specify communication needs or requirements
Are there any access requirements?*
Please specify access requirements
Advocate and Guardian information:
Does the client have:*
Name
Address
Street Address Suburb State Post Code
Telephone
Email
Service Agreements, payment method and referrer details:
Who will sign the Service Agreement:*
Name
Email
The Service agreement I wish to receive:*
Payment method:*
Company name*
Contact name*
Address*
Street Address Suburb State Post Code
Telephone*
Email*
Referrer details:*
Company name
Referrer name*
Address*
Street Address Suburb State Post Code
Telephone*
Referrer Email*
Services and Assessments:
What services and assessments are specifically required? Please also advise of funding amount to be used for each service.*
- Behaviour Support Assessment and Behaviour Support Plan
- Behaviour Support Plan, Implementation and Training
- Implementation of Current Behaviour Support Plan
- Psychological Assessment
- Psychological Counselling
- OT Functional Assessment
- OT Skill Building
- OT Sensory Assessment
- OT Home Modification Assessment
- OT SIL Assessment
- OT Assistive Technology Assessment
- Excercise Physiology Assessment, Program and Training
- OT Environmental Risk Assessment
- Physiotherapy Assessment and Intervention
- Speech Pathology Communication Assessment
- Swallowing Assessment and Mealtime Management Plan Development
- Cognitive IQ/Assessment
- Speech Pathology Intervention
- Autism Diagnostic Assessment (NSW only)
- Letter of Recommendation
- Other
Behaviour Support Assessment and Behaviour Support Plan funding*
Behaviour Support Plan, Implementation and Training funding*
Implementation of Current Behaviour Support Plan funding*
Psychological Assessment funding*
Psychological Counselling funding*
OT Functional Assessment funding*
OT Skill Building funding*
OT Sensory Assessment funding*
OT Home Modification Assessment funding*
OT SIL Assessment funding*
OT Assistive Technology Assessment funding*
Excercise Physiology Assessment, Program and Training funding*
OT Environmental Risk Assessment funding*
Physiotherapy Assessment and Intervention other*
Speech Pathology Communication Assessment funding*
Swallowing Assessment and Mealtime Management Plan Development funding*
Cognitive IQ/Assessment funding*
Speech Pathology Intervention funding*
Autism Diagnostic Assessment (NSW only) funding*
Letter of Recommendation funding*
Other funding*
Initial Assessment:
Where do you want the initial assessment conducted*
Other*
Please list office of preference:*
Who will be present during the appointment?*
Who do we contact to organise appointments?*
Please provide ORS with a copy of previous allied health and medical reports and the most recent NDIS plan if possible.
Max. file size: 128 MB.
How did you hear about ORS:
How did you hear about ORS:*
Other:*
Risks and Safety
Has the participant ever been physically aggressive towards allied health, medical or support staff?*
Provide details:*
Has the participant been incarcerated in a prison, juvenile detention centre or spent time in a forensic hospital for violent or sexual offence?*
Provide details:*
Is the participant currently engaging in alcohol or drug use?*
Provide details:*
Are there any known risks for visiting the participant in their own home?*
Please Note: All dogs must be restrained or kept in another room for the duration of the appointment
Provide details:*
Diagnosis, Background and Restrictive Practices
Please list all disability, health and medical conditions and any background information (e.g. self-harm/suicide/homicide ideation or attempts) or urgency requests:*
Are there any restrictive practices in place?*
Provide details:*
Enquiry
Name*
First Last
Email*
Contact number
Please include area code
How can we help you?
How did you hear about ORS?
- Family/friend/colleague
- Previous ORS client
- Employer
- Medical professional
- Insurance Agent
- Google
- Facebook
- LinkedIn
- Other
Private Allied Health Services
Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Assessment Request:
- Psychological Counselling
- Vocational Assessment Report
- Worksite / Ergonomic Assessment
- IQ Assessment / Moderate Intellectual Loading Assessment
- Psychological Assessment
- Occupational Therapy Assessment
Referring Company:
Staff Member Name:
Referrer Address:
Referrer Phone:
Referrer Email:
Are the Billing Details different to the above?
- Yes
- No
Please complete the below:
Billing Company:
Staff Member Name:
Billing Address:
Billing Phone:
Billing Email:
Is an Interpreter Required?
- Yes
- No
Language
Job Barriers / Medical Information / Reason for Referral:
List
List

Services that work

Referral Form

Step 1 of 2

National Disability Insurance Scheme (NDIS):

Workplace Rehabilitation:

Psychological Services:

Workplace Rehabilitation

Worker Details

Claim Details (if applicable)

Insurance Details (if applicable)

Purpose of Referral

Referred by (if referred by insurer, write “Insurer”)

National Disability Insurance Scheme (NDIS) Referral Form

Client information:

Advocate and Guardian information:

Service Agreements, payment method and referrer details:

Services and Assessments:

Initial Assessment:

How did you hear about ORS:

Risks and Safety

Diagnosis, Background and Restrictive Practices

Enquiry

Private Allied Health Services

Please complete the below: