• Your Details

  • Date Format: DD slash MM slash YYYY
  • Referring Health Professional (eg Doctor) Details:

  • The referral form must be titled Referral form for Individual Allied Health Services under Medicare for patients with a chronic medical condition and complex care needs.
    An example of the form can be found here
    Please note: If any of the above details are missing from your form, you will need to return to your GP to amend your form
  • Declaration