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Referrals

CHG is pleased to receive referrals from external providers for our specialist, allied health and/or clinical services.

Please submit to us details as best you can and we’ll be in touch within one business day.  If you have any questions don’t hesitate to contact us on 8354 9800.

We thank you for your partnership as together we seek to ensure our mutual clients are provided with the best care and assessment options.

About the person completing this form:

Requested service:

PhysiotherapyHydrotherapyPain ManagementPsychologyOccupational PhysicianMedical Practitioner

Assessment

Return to Work Functional CapacityPermanent ImpairmentIndependent Medical ExaminationFitness for WorkPre-Employment

Worker / Patient details:

If there is an existing compensation claim, please provide details here.

Preferred Suburb*

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