Referral Form

Please Note:

  • The referral form can be completed by either a client, caregiver, health professional or educator with permission from the client/caregiver.
  • Please ensure you review our 'Fees & Payments' page for relevant information prior to making your referral request.
  • Our referral form incorporates our Privacy and Confidentiality Statement + Consent to Obtain and Release Information form as part of our commitment to protecting your privacy.
  • If you run into issues with this online referral form you can contact our office to complete a referral over the phone.
  • At certain times throughout the year we may have waiting lists for particular regions. To find out if there are waiting times in your region please contact the office.
  • Please note if you are a DVA White or Gold card holder you need to ask your GP to send a referral to our office and do not need to complete this form.