Continuity Care Referral Form

To maintain continuation of care during this unpresented time of COVID-19 outbreak, Continuity Care has increased the amount of support services to meet the need of new and existing clients. Please tick the services that you are looking for yourself or someone that you care about.

Referral kind

So we can collect the required information, please select which kind of referral this relates to.

Participant/client details

Decision maker (power of attorney, parent, guardian, etc) contact details (if applicable)

Referrer’s Details:

Submitting the form

Please submit the relevant information regarding the support required this can be your NDIS plan (relevant sections: About me, Improved daily living skills, Improved relationships) •Previous Care Plan, your GP and Hospital Discharge letters. Previous therapy assessments, medical information/diagnostics. If you are unsure about something or would like to chat with someone about this referral, please call 0451511200 and our customer service team will be happy to support you.

By submitting this form, I confirm that I am over 18 years of age, I agree to Continuity Care collecting the information in this form and contacting me about services that may be of interest to me. I have read and agree to the Privacy Policy and understand that I can unsubscribe at any time from marketing communications by emailing [email protected]