REFER TO US

Unsure where to start? Our team will guide you through the next steps in your journey

REFERRAL FORM

We have immediate capacity to welcome new patients into the Team Rehab Solutions community. Our streamlined administrative systems and highly supported clinical team ensure your clients receive consistent, high-quality care without long wait times.

We accept referrals from general practitioners, specialists, practice nurses, allied health professionals, case managers, discharge coordinators, and community health organisations.

We understand that timely communication is essential for effective patient care, which is why we offer a two-hour response time for online referrals during business hours and ensure all clients are contacted within 24 hours of a referral being received.

To get started, please complete the form below or call us on 1300 685 046 to discuss how we can work together to achieve the best possible outcomes for your patients.

NDIS REFERRAL FORM

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Participant/Client Details

Please complete the information below to begin your referral.

Participant/Client Name

Date of Birth

Please Describe the Clients Gender

Aboriginal or Torres Strait Islander Origin

Area

Participant/Client Email

Participant/Client Phone Number

Address

Street Address City State Post Code Country

How did you find out about TRS?

NDIS Details

NDIS Number

The NDIS Plan is:

Self-Managed

Plan Managed

Agency Managed

NDIS Funding Approved

Yes

NDIS Report Required

Yes

Is your plan registered on the PACE System?

Yes

Services You Require

Physiotherapy

Occupational Therapy

Exercise Physiology

Podiatry

Dietitian

Speech Pathology

Additional Requirements

Functional Capacity Report

Therapy

Home Modifications

Assistive Technology

Other

Functional Capacity Report

Initial Report

FCA

SIL

SDA

Other

Therapy

Life Skills Therapy (Budgeting, Meal Prep, Personal Organisation

Upper Limb Rehabilitation

Cognitive Rehabilitation

Fatigue Management / Sleep Hygiene

Other

Home Modifications

Minor Mod (removable ramp, grab rails, non-structural changes)

Major Mods (bathroom modification, concrete ramp, door widening/automation, high-cost structural building changes)

Assistive Technology

Low Cost AT / Simple (dressing aids, adaptive kitchen aids, low cost mobility aids including 4WW and walking stick

High Cost / Complex AT (mobility scooter or powered wheelchair)

High Cost / Complex AT (manual wheelchair)

High Cost / Complex AT (mobile shower commode)

High Cost / Complex AT (manual floor hoist)

High Cost / Complex AT (other)

Other

Behaviour Support

Driving Assessment and/or Vehicle Modifications

NDIS Access Report (to be submitted to the NDIA with an access request - this report is for individuals who are not yet participants of the NDIS

Other

Reason for visit and NDIS Goals

What do you hope to achieve from the Physio/OT/EP/Podiatry/Dietitian/Speech Pathology appointment?

Primary Diagnosis

This is the disability you have met access to the NDIS for.

General Medical History

Please share any relevant medical history/diagnosis (please include Mental Health history) that would be beneficial for the clinician to be aware of.

Support Coordinator Details

Please complete this section if applicable.

Support Coordinator Company Name

Support Coordinator Name

Support Coordinator Phone

Support Coordinator Email

Plan Manager Details

Please complete this section if applicable.

Plan Manager Company Name

Plan Manager Address

Plan Manager Phone

Plan Manager Email

Participant Name

Please complete to acknowledge your agreement of the above.

Date of Birth

Home Visit Safety Checklist

Is there parking available on-site? Is the property visible from the street?

Yes

Please provide further information

Is there Phone Reception on the Property?

Yes

Are There Pets in the House?

Yes

We kindly requst that dogs/cats be put away during the clinicians visit.

Will anyone else be present during the appointment?

Yes

Name and Relationship to the Client

Is the client a smoker?

Yes

Please kindly refrain from smoking during the home visit as it is part of workplace safety regulations. Any breaches will result in termination of the home visit, with applicable charges still applying.

Does anyone on the property have a criminal history?

Yes

Please Provide Details

Are there any firearms or weapons stored on the property?

Yes

Please confirm they will be securely stored/locked as per relevant laws.

Does anyone living in the house have a history of abuse, aggression, challenging behaviours, excessive drug/alcohol use or violence that may impact work safety?

Yes

Please Provide Details

Does anyone living in the house have an infectious disease (Eg. COVID, MRSA)

Yes

Please Provide Details

Other Comments?

Is there anything else that the therapist needs to be aware of prior to attending the home visit?

Emergency & Disaster Plan

In some circumstances where there may be a disruption to the Participants care such as in natural disasters or pandemics. In such events the Provider will endeavour to prioritise the Participants preferences for continuity of care. Please indicate with descending numbers where 1 is the highest preference. This is so we can work with you to ensure your preferences are taken into consideration when these unfortunate events occur. Please only use each number once.

Via telehealth with another clinician