Privately Paid Allied Health Online Referral

Advocate and Guardian Information

Referrer Information

Services Required

Diagnosis and Background

Documentation

Please provide a copy of any relevant previous allied health and medical reports, if available.

Risks and Safety

Initial Assessment

Service Agreement

Payment Method

Further Information

Disclaimer

ORS will attempt to contact the nominated person in the referral from as soon as the referral has been processed to schedule an appointment at the earliest and most convenient time. If we are unable to contact you via telephone and you have indicated a preferred appointment day and time when completing the referral, we will do our best to schedule at, or around this time and send you an SMS and email with these details. If no appointment day and time were indicated on the referral form, we will need to make contact to confirm a suitable day and time for the appointment and will send you an SMS and email which can be responded to outlining preferred days and times. If we do not hear back from you within ten business days after attempting our first contact, we will be required to close the case to make space for other clients requiring ORS Services.