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Referrals

Make a referral

For insurers, case managers, employers, GPs, lawyers, support coordinators, schools and families. We'll make the appointment or get back to you within 48 hours.

1. What kind of referral is this?
2. Your details
Full name
Organisation or practice
Role
Phone
Email
3. The person you're referring
Full name
Date of birth
Phone
Email
Suburb and postcode
Interpreter needed?
4. Claim and funding
Scheme or insurer
Claim number
Date of injury
Type of injury
Funding approval
Case manager or claims officer
4. NDIS plan
Plan management
Budget the support will come from
NDIS number
Plan end date
Plan manager (name and email)
Support coordinator (name and email)

We are not a registered NDIS provider, so we can't support NDIA-managed plans.

4. Your organisation
Organisation name
ABN
Service needed
Is there a workers' compensation claim?
Do you have a service agreement with us?
4. Medical referral
Practice name
Referring practitioner
Funding, if known

Prefer to fax? Send your referral letter to (07) 3544 7732 and we'll contact your patient within 48 hours.

4. School referral
School name
Guidance officer or contact
Student's year level
NDIS plan management
Number of students who may need support
4. Funding
How will sessions be paid?
4. Report request
Law firm or insurer
Matter or claim reference
Report type
Report needed by
5. Services and sessions

Services you're asking for (tick any that apply)

Where would sessions suit best?
Reason for referral and anything we should know
6. Invoicing contact
Name
Email
Phone
Purchase order or approval number
7. Documents
Referral letter, medical reports or plan pagesPDF, Word or images. Up to 5 files, 10 MB each.
How did you hear about us?
8. Consent

Read our privacy collection notice. Privacy questions can go to privacy@eclosia.au. Please don't include more health information than we need to make contact. We'll gather the rest securely.