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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