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Make A Referral

Refer a patient

The below services have fillable referral forms, for all other services please see A-Z service pages for contact or referral instructions:

Antenatal Care Referral Form
Community Health – Camperdown & Lismore Referral Form
Community Health – Paediatrics Referral Form

Child and Family Questionnaire

Community Health – Warrnambool Referral Form
Community Palliative Care Referral Form
Day Stay Unit Referral Guidelines

Referral Form

Consent to Operation / Procedure Treatment

Discharge Support and Liaison Referral Referral Form

Services included on this form:

  • Inpatient Rehabilitation (Rehabilitation or GEM (Geriatric Evaluation and Management))
  • Transition Care Program (home based or bed based).
  • Home with Supports (E.g. Care co-ordination: PAC/Complex Care)
  • GEM @ Home
  • RITH (Rehabilitation In The Home)
Fracture Clinic Referral Form
Gynaecological Care Referral Form
Healthy Mothers Healthy Babies Referral Form
NDIS Referral Form
Pain Rehabilitation Clinic Referral Form
Specialist Outpatient Clinics Referral Guidelines

Referral Form

Services included on this form:

  • Diabetes Mellitus Type 1,
  • Diabetes Mellitus Type 2,
  • Endocrinology,
  • General & Acute Care Medicine,
  • Heart Failure Services,
  • Hypertension,
  • Movement Disorder,
  • Nephrology/ Renal Medicine,
  • Neurology,
  • Perioperative Review,
  • Rheumatology,
  • Stroke.

 

Page last updated: 23 January 2025

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