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  • 13000 HELPU

Referrals Form

For existing Clients already receiving services through Empower Healthcare please simply email community@empowerhealthcare.com.au with your additional request – no new referral form is necessary.

1 Referrer
2 Client Details
3 Referral Information
4 Medical Details
5 Funding Details
  • Referrer

  • Client Details

  • Please select yes for any client that has been referred to Empower Healthcare for Allied Health services in the past 24 months .
  • Date Format: DD slash MM slash YYYY
  • This one for Group Assigning
  • Specify if you are aware of any issues that may impact on client, carer or service provider safety.

    If there is a possibility of the Client or family member being aggressive toward the service provider, then the Case Manager must be present for appointments. Aggressive or threatening behaviour will not be tolerated and if the service provider feels unsafe at any time they have the right to leave the premises and refuse future treatment.
  • Referral Information

  • Date Format: DD slash MM slash YYYY
  • NB: All new clients will require an Initial Assessment after which the Speech Pathologist will provide you with a comprehensive report and recommendations for ongoing care. Initial assessments are 3Hours including Face to Face AX, Report writing, documentation and Travel
  • Please Note that we can only book in Nursing referrals once we have Full Medical History, Medication Summaries and relevant GP Authorization – please ensure you have attached these to the medical information page before submitting your referral
  • Medical Details

  • This is a required field
  • Drop files here or
    Accepted file types: pdf, jpg, rtf, doc, docx, zip, txt.
  • Drop files here or
    Accepted file types: pdf, jpg, rtf, doc, docx, zip, txt.
  • GP details

  • Funding Details

  • PLEASE NOTE – We are unable to book in any appointments for NDIS Participants without a signed NDIS Service agreement or NDIS terms agreed in writing. A friendly member of our team will email you the agreement and requests for any additional information shortly. Once we receive this back we will book in the appointment and confirm with you via email.
  • Please enter start and end date: (e.g. 12/01/2019 - 12/02/2020)
  • eg, NDIS Service agreement, Clients Goals, Discharge letters etc
    Drop files here or
    Accepted file types: jpg, pdf, doc, docx, rtf, zip, txt.
  • This is a required field
    Additional OT F/U Disclaimer: After an initial OT assessment has taken place and the relevant report and quote (x1) has been submitted, any requests for the OT to complete additional follow ups, whether administrative or not will be charged at 15 minute increments. An invoice will be sent the Monday after the additional follow up has taken place.
    Recommendation Disclaimer:
    Based on an assessment of your client Empower Healthcare clinicians will make recommendations on services or products from third party organisations. Empower Healthcare does not indemnify / guarantee third parties and does not take responsibility for the services or products purchased through these organisations.
    Cancellation Policy:
    Empower Healthcare require 24 hours’ notice for any cancellations. Clients will be charged full fee for anything under this time.

    By submitting this referral to Empower Healthcare you are confirming you have consent to do so and have read and understood our above cancellation policy and disclaimer.
  • Please press the submit button once - it may take a minute to send all your data.
  • This field is for validation purposes and should be left unchanged.

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Info@empowerhealthcare.com.au

ABN 89 611 713 396
Call 13000 HELPU

VICTORIA

1 Cochranes Road
Moorabbin
VIC 3189

Call 03 9583 1364

NEW SOUTH WALES

Level 35, Tower One,
International Towers,
100 Barangaroo Avenue
NSW 2000

Call 02 9188 4141

WESTERN AUSTRALIA

Level 11, Brookfield Place,
125 St Georges Terrace, Perth
WA 6000

Call 08 6558 0848
Copyright 2021 © © Empower Healthcare
  • Aged Care
    • Shape Created with Sketch.

      Aged Care Intro

      Physiotherapy

      Combined Shape Created with Sketch.

      Podiatry

      Dieticians

  • Home Care
    • Shape Created with Sketch.

      Home Care Intro

      doctor-2-outline

      Home Nursing

      Teletherapy Service

      Physiotherapy

      Occupational Therapy

      Combined Shape Created with Sketch.

      Podiatry

      Osteopathy

      Dietitians

      Massage Therapy

  • NDIS
    • NDIS Intro

      doctor-2-outline

      Home Nursing

      Teletherapy Services

      Occupational Therapy

      Physiotherapy

      Combined Shape Created with Sketch.

      Podiatry

      Dietitian Services

  • About Us
    • Our Story
    • Blogs
    • Feedback
  • Careers
    • Join Us
    • Graduate Program
  • Referral Form
  • Contact us

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