Make A Referral

At Real Therapy Solutions, we understand that your time is valuable. That’s why we’ve made referring to us as easy and quick as possible. Simply fill in our quick referral form, and you’ll be on your way to receiving the support you need. We ensure a streamlined process so that you can focus on what truly matters—your well-being. If you prefer to discuss your referral contact us on 1300 856 617 or email at referral@realtherapysolutions.com.au.

Let's get started

I am a Participant

I am a Referrer or Nominated Representative

Step 1 of 2

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Participant
Tell us about you

Date of Birth(Required)

MM slash DD slash YYYY

Postcode(Required)

ZIP / Postal Code

Reason for referral

Services Required

How would you/participant prefer to receive our services?(Required)

Telehealth

Face-to-face

Either

Which services are you/participant interested in?

Occupational Therapy

Speech Pathology

Psychology

Positive Behaviour Support

Key Worker

I am unsure

Do you have an approved NDIS plan or are you awaiting approval?

I have an approved plan

I am awaiting approval

PlanDetails

NDIS participant number(Required)

Plan Start Date(Required)

MM slash DD slash YYYY

Plan End Date(Required)

MM slash DD slash YYYY

How will funds be claimed?(Required)

Agency Managed

Plan Managed

Self-Managed

Attach Documents (Optional)

Max. file size: 80 MB.

My Details

Your role(Required)

Parent

Support Person

Support Coordinator

Other

First Name(Required)

Last Name(Required)

Phone

Your Email(Required)

Postcode(Required)

ZIP / Postal Code

Consent

I would like to save my profile information to future referrals

Step 1 of 4

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STEP 1: Tell us about yourself

I am a (please select what is appropriate):(Required)

NDIS Participant
If so, go directly to STEP 2

LAC/Support Coordinator

Parent

Plan Manager

Support Person

Other

Please specify

If you are not the participant, please tell us:

Your first name(Required)

Your last name(Required)

Your phone number(Required)

Your email address

Your postcode(Required)

ZIP / Postal Code

STEP 2: Tell us about the participant If you are not the participant, please tell us:

Participant's first name(Required)

Participant's last name(Required)

Participant's preferred name

Participant's gender(Required)

Participant's preferred pronoun

Participant's date of birth(Required)

MM slash DD slash YYYY

Participant’s address and contact details

Address(Required)

Number and street details Suburb State Postcode

Phone(Required)

STEP 3: The services required

Select a clinic based on your location(Required)

Which services are you interested in?(Required)

Occupational Therapy

Speech Pathology

Psychology

Positive Behaviour Support

Key Worker

I am unsure

How would you prefer to receive these services?(Required)

Face-to-face

Telehealth

Either/both

Do you have an approved NDIS plan or are you awaiting approval?(Required)

I am awaiting approval

I have an approved plan

If you have an approved plan, are you ready to share this with us now?

Yes (If yes, please answer the following questions:)

No (If no, we will call you at a later time to discuss)

NDIS participant number(Required)

Plan Start Date(Required)

MM slash DD slash YYYY

Plan End Date(Required)

MM slash DD slash YYYY

How will funds be claimed?(Required)

Agency Managed

Plan Managed

Self-Managed

Please attach additional information documents as required

Max. file size: 80 MB.

STEP 3: The services required

Reason for referral

Primary disability

Other relevant health information

Is there a Guardian involved?

Yes

If your answer is “Yes”, please answer the following questions

Name

Phone

Is there a Support Coordinator involved?

Yes

If your answer is “Yes”, please answer the following questions

Name

Phone

Who is the Plan Nominee or Child Representative?

Yes

If your answer is “Yes”, please answer the following questions

Name

Phone

Will an interpreter be needed?

Yes

If yes, please specify preferred language:

STEP 5: Save and submit this form
Please save the document and email it as an attachment to referral@realtherapysolutions.com.au
Please also attach additional information documents as required.
Thank you for making a referral to Real Therapy Solutions. We are looking forward to supporting you to get more out of life today.

Consent

I would like to save my profile information to future referrals

Make a referral

Let's get started

I am a Participant

I am a Referrer or Nominated Representative

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