Our referral form is created as a word template so that you can add/copy detail at your preference. Please click the image above, or here to download a copy. If you are having problems opening the Microsoft Word version, you can also download a PDF version of our referral form here.

The form has been designed to be compliant with screen readers for those with low vision/blindness.

All WHR Allied Health clients will be required to have discussed/completed our WHR Privacy, Consent and Service Agreement Form (or for self-funded clients, our WHR Allied Health Self-Funded Privacy, Consent and Service Agreement Form) before supports can commence or continue. We welcome discussion around the content of these documents prior to them being completed and whilst you are receiving supports.

Once completed, please return a copy of the referral details to along with any relevant attachments that are likely to assist us in providing therapeutic supports. Alternatively, if you would prefer to provide these details by phone, please contact 03 5261 9037 or 0431 556 720.