1300 550 770

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1300 550 770
Members Login

Home
About us
Services
FAQs
Referral Form
Rehab Provider
Our Blog
Contact Us
Training

Contact

We love hearing from you!

Locations and Contact Details

Head Office

Ph: 1300 550 770

PO Box 851
North Sydney, NSW 2060

Sydney

50 Miller Street
North Sydney NSW 2060

Melbourne

11-19 Bank Street
Melbourne VIC 3000

Newcastle

1 Tudor Street, Newcastle NSW 2300

Blacktown

Shop 4023, 17 Patrick Street
Blacktown, NSW 2148

Penrith

95B Station Street
Penrith, NSW 2750

Wollongong

Ground Floor, Enterprise 1, Innovation Campus, Squires Way
North Wollongong, NSW 2500

Coffs Harbour

4/30 Orlando Street
Coffs Harbour, NSW 2450

Tamworth

307 Peel Street
Tamworth, NSW 2340

Referral Form

Page 1 of 6 - Get Started

To request a referral please use our online referral form. On submission an email will be sent to our referral team who will contact you within 24 hours.

When using the form please note that all fields marked with a red bar are required and you will not be able to progress to a subsequent page unless they have been completed.

Start by simply selecting the state in which you work and the service or scheme you wish to access...

Please choose the state in which you work

Which Scheme or Service Stream do you require (options will change when state is chosen)

Scheme or Service Stream

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Funds Approved

Liability Status

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

No Choice Required

Services Required

No Choice Required

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther

Services Required

No Choice Required

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

No Choice Required

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentS40 AssessmentADL AssessmentOther

Funds Approved

Liability Status

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

No Choice Required

Services Required

No Choice Required

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther

Services Required

No Choice Required

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

No Choice Required

Services Required

No Choice Required

Funds Approved

Liability Status

Services Required

No Choice Required

Services Required

No Choice Required

Services Required

No Choice Required

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

No Choice Required

Services Required

No Choice Required

Funds Approved

Liability Status

Services Required

No Choice Required

Services Required

No Choice Required

Services Required

No Choice Required

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

No Choice Required

Services Required

No Choice Required

Funds Approved

Liability Status

Services Required

No Choice Required

Services Required

No Choice Required

Services Required

No Choice Required

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

No Choice Required

Services Required

No Choice Required

Funds Approved

Liability Status

Services Required

No Choice Required

Services Required

No Choice Required

Services Required

No Choice Required

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

No Choice Required

Services Required

NESWorksute AssessmentFunctional AssessmentVocational AssessmentOESInitial AssessmentADL AssessmentOther

Funds Approved

Liability Status

Services Required

Initial AssessmentOther

Services Required

No Choice Required

Services Required

No Choice Required

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther

Services Required

No Choice Required

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

No Choice Required

Services Required

No Choice Required

Funds Approved

Liability Status

Services Required

No Choice Required

Services Required

No Choice Required

Services Required

No Choice Required

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther

Services Required

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther

Services Required

No Choice Required

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Page 2 of 6 - About the Claimant

Please enter your personal details on this page

Claimant Name

First Name

Last Name

Claimant Address

Street or Mail Address

Suburb

State

Post Code

Date of Birth

Claimant Emai

Phone (w)

Phone Number

Mobile Phone

Phone Number

Is an interpreter required?

NoYes

Injury Type

Date of injury

Claim Number

Pre-Injury wage / wk.

Pre-injury hours / wk.

Pre-injury Role

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Page 3 of 6 - Employer Details

Employer Name

Employer Address

Mailing Address

Suburb

State

Post Code

Country

Who should we Contact (person or department)

First Name

Last Name

Phone (work hours)

Mobile

Phone Number

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Page 4 of 6 - Agent / Insurer Details

Agent Company

Agent Address

Steet / Mail Address

Suburb

State

Post Code

Agent Name

First Name

Last Name

Phone (work / mobile)

Phone Number

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Page 5 of 6 - Doctor Details

Doctor's Name

First Name

Last Name

Address

Steet / Mail Address

City

State

Post Code

Phone / Mobile

Phone Number

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Page 6 of 6 - Final Submission

Referrer

Name of Association

Comments

Approved By

Please leave this field empty.

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Contact Us

Please do not use this form for referrals - use the form on our Referral Page instead.
If you wish to pay an invoice please click here.

Your Details

First Name

Last Name

Your Email

Your Phone

- Area Code

Phone Number

Reason for Contact

Please upload your resume in PDF or Word format

Comments

Please leave this field empty.

Want to reduce the financial and physical cost of injury to your workplace? Interested in receiving quality tips, news and updates on safety management?

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Referrals
referrals@workoptions.com.au

Mail
PO Box 851, North Sydney

Phone
1300 550 770

Pay an Invoice
ABN: 33 100 837 170

Home
About Us
Services
Referral Form
Contact Us
Training
Preferred Rehab Provider
Members Login
FAQs

Contact

We love hearing from you!

Locations and Contact Details

Head Office

Sydney

Melbourne

Newcastle

Blacktown

Penrith

Wollongong

Coffs Harbour

Tamworth

Referral Form

Page 1 of 6 - Get Started

Which Scheme or Service Stream do you require (options will change when state is chosen)

Page 2 of 6 - About the Claimant

Page 3 of 6 - Employer Details

Page 4 of 6 - Agent / Insurer Details

Page 5 of 6 - Doctor Details

Page 6 of 6 - Final Submission

Contact Us

Please do not use this form for referrals - use the form on our Referral Page instead. If you wish to pay an invoice please click here.

Please do not use this form for referrals - use the form on our Referral Page instead.
If you wish to pay an invoice please click here.