Referral Form

Please enter your referral below. To ensure all information is captured correctly, please follow these instructions:

  1. Complete the fields on screen and select NEXT
  2. 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)
  3. The form will time out if left unattended so please gather information beforehand
  4. Once all the referral information is entered, click SUBMIT

If you have any issues, please call 1300 034 503 or email

Once your referral has been submitted, an intake clinician will be in touch within 2 – 3 business days.