• Early Intervention Referral Form

  • Company / Employer Details

  • Click on this link to continue filling out the MRL referral form.

  • Click on this link to continue filling out the Civeo referral form.

  • Click on this link to continue filling out the Westrac referral form.

  • Click on this link to continue filling out the Watercorp referral form.

  • Click on this link to continue filling out the Crown referral form.

  • Click on this link to continue filling out the Compass referral form.

  • Click on this link to continue filling out the Swick referral form.

  • Click on this link to continue filling out the South Metro Health referral form.

  • Patient / Injured Worker Details

  • Format: (+61) 0000-000-000.

  • Injury Details

  • Injury Management Advisor/Employer Representative Details

  • Format: (+61) 0000-000-000.

  • Early Intervention Services

  • Services Requested (Select Multiple if appropriate)*
  • Reporting Requirements (PT, OT, PSYCH) Please select the level of reporting required and the preferred form of communication throughout the early intervention program.*
  • Reporting Requirements (EP) Please select the level of reporting required and the preferred form of communication throughout the early intervention program.*
  • Please select your preferred Communication Method for session updates*
  • Do you approve cost of consumables if required? e.g. splint/brace etc.*
  • Would you like to add a Medical (Doctor Consult) to your request?
  • Please select the Medical Certificate type required for the consult
  • Are referrals for additional services approved under the referral (e.g. specialist, allied health, psychology)?
  • Please select the investigation services approved under the referral*

  • Please provide your preferred appointment requirements.

    We will endeavour to schedule the next closest available day and time to suit your preferences and will email you with the appointment details once confirmed.

  • Preferred Date
     - -
  • AM or PM? Choose all that apply.
  • Western Australia or Queensland?
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  • RediMed Early Intervention Pricing & Billing

  • RediMed WA Early Intervention Pricing
  • RediMed WA Early Intervention Pricing
    • If multiple discipline services are required, costings will be as per each allied health service separately.
    • GP/Medical Consult: Aligned to state-based Workers Compensation gazetted rates
    • Quoted costs are inclusive of all consultation, communication and report costs, if service is not provided, total cost will decrease.
    • Consumables are charged separately.
    • Any additional phone calls or email correspondence outside of the package inclusions will be charged at a rate of $24.10 + GST per 6 minutes.
    • Early Intervention prices are increased annually in line with the state based WorkCover gazetted rates.
    • Invoicing is completed following each session and will be itemised with consult, communication and consumables 
    • If a final report is requested, cost is additional  
    • Prices are exclusive of GST 
    • Our pricing is subject to RediMed’s Standard Terms and Conditions.

  • Please review both links below to our privacy policy prior to completing the form. https://www.redimed.com.au/privacy-policy/

    https://www.redimed.com.au/terms-and-conditions/

     

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