Please complete and submit this online referral form for your patient or client, or email your referral to

Referral details

If a letter of referral is not uploaded, please provide the name, date of birth and contact phone number of your patient or client, along with your name and contact details.

Yes, send me an email confirmation of this referral

If your patient is experiencing a medical emergency, please contact your local emergency department or dial 000.

Submission of an online referral does not automatically constitute acceptance of the referral.

We will contact your patient, and you will be advised of the outcome within one (1) business day from submission of your referral.