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Refer

No boundaries. Just opportunities.

Choose the team with over 25 years experience in provision of Workplace Rehabilitation, Psychological Services 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.

If you would like to make a PHaMs referral, please complete a PHaMs Referral Form.

Step 1 of 2

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Please select one of the following services*
- Workplace Rehabilitation Referral Form
- National Disability Insurance Scheme (NDIS) Referral Form
- Psychological Services
- Training Services
- General Enquiry

Workplace Rehabilitation:
National Disability Insurance Scheme (NDIS):
Psychological Services:
Workplace Rehabilitation
Claim Number
Workers Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone (home)
Phone (work)
Interpreter required
- Yes
- No
Language
Reason for referral
Nature of injury
Date of injury/accident
Is the injured worker presently working
- Part-time
- Full-time
- Not working
Date they ceased work
Occupation
Average weekly earnings
Employer
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Contact name
Treating doctor
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Fax
Referred by
- Employer
- Doctor
- Insurer
- Self
Name of referrer
Phone
Referrer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Approved costs
In which state has this Workers’ Compensation Claim been made*
- ACT
- NSW
How did you hear about ORS Group?
- Medical professional
- Family/friend/colleague
- Employer
- Previous ORS Group client
- Insurance Agent
- Google
- Facebook
- LinkedIn
- Flyers
- Other
Upload Files
Drop files here or
please attach any supporting information
National Disability Insurance Scheme (NDIS)
Date of referral
Customer full name
NDIS number
NDIS Plan - start date
NDIS Plan - end date
Customer address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Customer telephone
Customer email*
Customer date of birth
Customer gender
- Male
- Female
- Non-binary
- Prefer not to say
Communication communication preferences / requirements
- Telephone
- Email
- Face to face
Interpreter required
- Yes
- No
Language
Can ORS contact the customer directly to book appointments?
- Yes
- No - please specify alternative contact person:
Advocate name
Advocate Phone
Advocate Email
Are there any access/reasonable adjustment requirements?
- No
- Yes - please specify below:
Specify Access Requirements (if required)
Is this a self referral?
- Yes
- No
Name of referrer (Your name)
Company/Organisation (if applicable)
Email
Phone
NDIS support area
- Finding and keeping a job
- Improved health and wellbeing
- School leaver employment support
- Improved learning
- Improved relationships
- Improved daily living
- 2 or more of the above supports
Funding amount avaliable for this service to be provided
If mulitple support categories please define below and indicate funding
What services/assessments are specifically required
ORS is committed to supporting all customers, to help us ensure appropriate support and consultant/s are allocated, please list any relevant criminal history (time in prison or a forensic mental health hospital), aggressive and/or challenging behaviours.
Payment method
- NDIA
- Self-Managed
- Plan Managed
Plan Manager - Company Name
Plan manager name
Phone
Email
How did you hear about ORS Group?
- Support coordinator
- Medical professional
- Family/friend/colleague
- Previous ORS Group client
- Google
- Facebook
- LinkedIn
- Flyers
- Other
Upload Files
Drop files here or
please attach any supporting information
Enquiry
Name*
First Last
Email*
Contact number
Please include area code
How can we help you?
How did you hear about ORS Group?
- Family/friend/colleague
- Previous ORS Group client
- Employer
- Medical professional
- Insurance Agent
- Google
- Facebook
- LinkedIn
- Other
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Enquire Now

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