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 to create a service booking.

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):
General Enquiry:
Workplace Rehabilitation:
Psychological Services:
Private Allied Health Services:
Hidden
Workplace Rehabilitation
Referrer Information
Referrer Name*
Company Name*
Phone
Mobile
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Referrer Type (please select)*
- Insurer
- Treating Doctor
- Injured Worker
- Employer / Business Owner
- Allied Health Professional
- Other (please specify)
Other (please specify)*
Please tick all services and/or assessments specifically required? Please also advise of funding amount to be used for each service (if known)
- Recovery at work ongoing coordination services – Same Employer
- Recovery at work ongoing coordination services – New Employer
- Initial Needs Assessment
- Workplace Assessment
- Vocational Counselling
- Vocational Assessment
- Functional Capacity Evaluation – Physical
- Functional Capacity Evaluation – Psychological
- Ergonomic Assessment
- Manual Handling Training
- Labour Market Analysis
- Job Seeking Skills Assistance
- Medical Case Conference
- Activities of Daily Living Assessment
- Mediation
- Pre-employment Screening
- Employee Assistance Program (EAP)
- Earning Capacity Assessment
- Other (please specify)
Recovery at work ongoing coordination services – Same Employer
Please enter a number greater than or equal to 0.
Funding
Recovery at work ongoing coordination services – New Employer
Funding
Initial Needs Assessment
Please enter a number greater than or equal to 0.
Funding
Workplace Assessment
Please enter a number greater than or equal to 0.
Funding
Vocational Counselling
Please enter a number greater than or equal to 0.
Funding
Vocational Assessment
Please enter a number greater than or equal to 0.
Funding
Functional Capacity Evaluation – Physical
Please enter a number greater than or equal to 0.
Funding
Functional Capacity Evaluation – Psychological
Please enter a number greater than or equal to 0.
Funding
Ergonomic Assessment
Please enter a number greater than or equal to 0.
Funding
Manual Handling Training
Please enter a number greater than or equal to 0.
Funding
Labour Market Analysis
Please enter a number greater than or equal to 0.
Funding
Job Seeking Skills Assistance
Please enter a number greater than or equal to 0.
Funding
Medical Case Conference
Please enter a number greater than or equal to 0.
Funding
Activities of Daily Living Assessment
Please enter a number greater than or equal to 0.
Funding
Mediation
Please enter a number greater than or equal to 0.
Funding
Pre-employment Screening
Please enter a number greater than or equal to 0.
Funding
Employee Assistance Program (EAP)
Please enter a number greater than or equal to 0.
Funding
Earning Capacity Assessment
Please enter a number greater than or equal to 0.
Funding
Other (please specify)
Please enter a number greater than or equal to 0.
Funding
Insurer Information
Insurer Information*
- Matches referrer information
- Provide details
Insurer Name*
Company Name*
Phone*
Email
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Worker Information
Worker Information*
- Not applicable
- Provide details
Worker Name*
Medical centre / Clinic name*
Phone*
Mobile*
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Origin*
- Aboriginal/Torres Strait Islander
- Culturally and Linguistically Diverse
- Not Applicable
Interpreter required*
- No
- Yes (please specify)
Language (please specify)*
Does the client have any communication needs or requirements?*
- No
- Yes (please specify)
Provide details*
Are there any access requirements?*
- No
- Yes (please specify)
Provide details*
Claim Number
Date of Injury
MM slash DD slash YYYY
Pre-injury weekly earnings
not applicable
- not applicable
Nature of Injury and Diagnosis
Current capacity for work
- Certificate of capacity attached
- No current capacity
- Reduced capacity (at work)
- Reduced capacity (not at work)
- Full capacity
Please attach certificate of capacity*
Drop files here or

Max. file size: 2 MB.
Treating Doctor Information
Treating Doctor Information*
- No
- Yes (please specify)
Full Name
Medical Centre / Clinic Name
Phone*
Fax*
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Additional comments or information
Additional Treating Party Information
Additional Treating Party Information*
- No
- Yes (please specify)
Full Name
Medical Centre / Clinic Name
Phone*
Fax*
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Additional comments or information
Risks and Safety
Has the participant ever been physically aggressive towards allied health, medical or support staff?*
- No
- Yes (please specify)
Please specify*
Are there any known risks for visiting the participant in their own home?*
- No
- Yes (please specify)
Please specify*
How did you hear about ORS?
How did you hear about ORS?
- Google search
- Word of mouth
- Previously used ORS
- Currently using ORS
- Other (please specify)
Please specify*
Hidden
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:*
Preferred consultant:
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: 2 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
- Speech Pathology 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):

General Enquiry:

Workplace Rehabilitation:

Psychological Services:

Workplace Rehabilitation

Referrer Information

Insurer Information

Worker Information

Treating Doctor Information

Additional Treating Party Information

Risks and Safety

How did you hear about ORS?

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: