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Page 1 of 6 - Get Started

Tto 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...

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

Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
No Choice Required
No Choice Required
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther
No Choice Required
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
No Choice Required
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentS40 AssessmentADL AssessmentOther
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
No Choice Required
No Choice Required
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther
No Choice Required
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
No Choice Required
No Choice Required
No Choice Required
No Choice Required
No Choice Required
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
No Choice Required
No Choice Required
No Choice Required
No Choice Required
No Choice Required
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
No Choice Required
No Choice Required
No Choice Required
No Choice Required
No Choice Required
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
No Choice Required
No Choice Required
No Choice Required
No Choice Required
No Choice Required
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
No Choice Required
NESWorksute AssessmentFunctional AssessmentVocational AssessmentOESInitial AssessmentADL AssessmentOther
Initial AssessmentOther
No Choice Required
No Choice Required
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther
No Choice Required
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
No Choice Required
No Choice Required
No Choice Required
No Choice Required
No Choice Required
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
Initial AssessmentFunctional AssessmentVocational AssessmentPlan ManagementADL AssessmentOther
Return to Work Plan - Same EmployerReturn to Work Plan - New EmployerInitial AssessmentWorksite AssessmentErgonomic AssessmentFunctional AssessmentVocational AssessmentADL AssessmentOther
No Choice Required

Page 2 of 6 - About the Claimant

Please enter your personal details on this page

NoYes

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