Workplace Rehabilitation and Health Referral Form
If you have any issues with this referral form or require more support, please contact us at email@example.com or by calling 1800 000 677.
Claim Information and Diagnosis
Please provide a copy of any previous medical reports, certificate of capacity or any other relevant documentation, if available.
Accepted file types: .xlxs, .jpg, .jpeg, .doc, .docx, .pdf, .png
Please note: We endeavour to process referrals within 2 business days and will call you to schedule an appointment. If we are unable to make contact by telephone, we will schedule the appointment and email this to the contacts provided in this referral form. This email will confirm the appointment date and time, and any additional documentation or information required prior to the appointment. We would appreciate you looking out for this email and letting us know as early as possible if it needs to be rescheduled.
If your referral is urgent, please call us on 1800 000 677.