Referrals

This field is for validation purposes and should be left unchanged.

Client Funding Type*

CHSP referrals temporarily paused

We've paused new CHSP referrals until June 1 2026 while we manage the utilisation of our current grant funding.

If your situation is urgent or clinically time-sensitive, please get in touch so we can talk it through:

Chat with us via the website
Send a message through our contact page
Call us on 1300 031 935

We appreciate your understanding and look forward to reopening referrals soon.

Referrals Required*

Dietitian

Exercise Physiology

Occupational Therapist

Massage Therapy

Physiotherapist

Speech Pathology

Allied Health Assistant

What type of Physiotherapy service do you need?

What type of Occupational Therapy service do you need?

Would you like to add information about the participant's AT-HM budget or % contributions?

Yes

AT-HM budget or % contribution information

Urgent / Emergency Referrals

Does this person need to be seen urgently?

Yes

Clinical Rationale for Triaging

Our triage process is for referrals where a patient's condition or situation necessitates prompt assessment or support. Please select the reason(s) for urgency.

Severity of Dysphagia / Choking risk

To help us triage appropriately please indicate if the client has or experience any of the following:

Requires feeding assistance

Coughing after fluids

Cognitive impairment

Gagging/choking

Please add extra details about why the referral is urgent

Client First Name*

Client Last Name*

Date of Birth

Client Address

Street Address Suburb Post code

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Client Address

Client Phone Number

Client Email Address

Would you like to add Next of Kin / Guardian Contact Details?

Yes

Next of Kin / Guardian Name

Relationship of Next of Kin / Guardian to Client

Next of Kin / Guardian Phone Number

CHSP Codes for Allied Health

Please add your CHSP codes for Allied Health OR attach your support plan at the end

Who is your private health insurer?

Aged Care Provider Name

Funding type if not listed

Primary disability(s) recognised on NDIS

Medical Conditions

NDIS number

NDIS plan dates

How is NDIS plan managed?

Email address for invoices to be sent to

Dietitian service - if agency managing your plan where would you like Dietetics invoiced to?

How many hours are you allocating to our allied health services?

Upload NDIS Plan and / or Behaviour Support Plan (if you feel comfortable sharing)

If you feel comfortable sharing this helps our clinical team to allocate your referral to the most suitable clinician.

Drop files here or

Max. file size: 1 GB.

Referrer's Name

Referrer's Phone Number

Referrer's Email (complete to receive copy of referral)

Goal for Referral

Medical Conditions

Safety Questions

Additional Information

Upload File (optional)

You can upload supporting documents such as a My Support Plan (Aged Care), GP referral, discharge summary.

Drop files here or

Max. file size: 1 GB.

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Please check this box when you are ready to submit your referral*

Please check this box when you are ready to submit your referral

Referrals

Referral Form

Other Ways to Refer

Phone 1300 031 935

NDIS Referral Form

Aged Care Referral Form