Make A Referral

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
Cognitive, Dementia, and Memory Service	Referral Guidelines 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
Public Fertility Care	Referral Guidelines
Specialist Outpatient Clinics	Referral Guidelines Referral Form Services included on this form: Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Gastroenterology / Endoscopy, Geriatric Medicine, Haematology (Dr H. Tsuji only), Neurology, Post-hospitalisation follow-up, Renal Medicine, Rheumatology, Stroke / TIA.
Virtual Internal Medicine Team	Referral Form

Page last updated: 11 May 2026