Early Intervention Referral Form

Patient / Injured Worker Details
Full Legal Name*

First NameLast Name
Patient Date Of Birth*
MM/DD/YYYY
Patient Email
example@example.com
Patient Phone Number*
Please enter a valid phone number.Format: (+61) 0000-000-000.

RediMed Early Intervention Pricing & Billing
- 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. The total cost of the program will not exceed the quoted price, exclusive of any approved consumables funding
- 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
YesNo
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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Company / Employer Details