Referrals Form

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.