Referral Form
Please enter your referral below. To ensure all information is captured correctly, please follow these instructions:
- Complete the fields on screen and select NEXT
- Wait for the detailed referral form to load (some browsers will require you to open the form in a new tab – if so, the form will present you a link to click)
- The form will time out if left unattended so please gather information beforehand
- Once all the referral information is entered, click SUBMIT
If you have any issues, please call 1300 034 503 or email intake@theactgroup.com.au
Once your referral has been submitted, an intake clinician will be in touch within 2 – 3 business days.
Please note this form is completed in two parts. A second page will load once you click next.
