(02) 9957 1300
GO

    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...

    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