Refer your participant For an ‘ask us anything’ chat:1300 647 789 Refer Your Participant Are you looking to refer your participant for our services?We’ve assisted individuals with our person-centered approach, ensuring they reach their service goals.We will coordinate an individualised program and work closely with you. Call 1300 OHS RTW (647 789) to speak to a friendly Recovery Partners consultant, fill in the form below or email us at enquiries@rrp.com.au with any questions. Step 1 of 12 8% Referral numberClaim NumberRefer Your Client Which service are you referring your client for?*SelectRehabSafetyWellbeingNDISOther Client Details Title*SelectDrMrMrsMsMissFirst Name*Last Name*NDIS Number*Date of Birth* MM slash DD slash YYYY Plan Dates* MM slash DD slash YYYY AddressYour Details (if you are not the participant) TitleSelectDrMrMrsMsMissFirst NameLast NameEmailPhone Number Client Service RequestDisability*Services Required*Approved HoursCan be agreed after first appointmentNDIS Goals*Management*Include Plan Manager details if applicableFunding* Support Coordinator ContactFirst Name*Last Name*Phone Number*EmailOther Worker Details Title*SelectDrMrMrsMsMissWorker First Name*Worker Last Name*Worker AddressWorker Phone*Worker DOB* MM slash DD slash YYYY Interpreter Required Yes No LanguageOccupation Employer DetailsEmployer Company*Employer Contact*Employer AddressEmployer Phone*Employer FaxEmployer Email Employer Site Contact Insurer DetailsI'd like to make a private claim No insurer is involved in this service request Insurer Company*Insurer Contact*Insurer AddressInsurer Phone*Insurer FaxInsurer Email Insurer Site Contact Injury DetailsDate of Injury* MM slash DD slash YYYY Nature of Injury*Cause of Injury* Nominated Treating Doctor (NTD)Not applicable Not applicable NTD Name*NTD Address*NTD Phone*NTD Fax Services Required – please select* Occupational Rehabilitation – Same Employer Occupational Rehabilitation – New Employer Return to Work Coordination Activities of Daily Living Assessment Job Bank Ergonomic Assessment Functional Assessment Vocational Assessment Job Seeking Workplace Assessment Fitness for Duties Assessment Other OtherServices Required* Hygiene Service - Noise Risk Assessment Hygiene Service - Mould Gap Analysis Hygiene Service - Asbestos WHS Management System Hygiene Service - Light WHS Training Workplace Assessment Fitness for Duties Assessment Ergonomic Assessment Other OtherWellbeing Services* Drug & Alcohol Testing EAP Services Return to Work Coordination Injury Triage Services Pre-Employment Assessment Ergonomic Assessment Job Task Analysis Workplace Assessment Manual Handling Training Psychological Awareness Training Fitness for Duties Assessment Other OtherWhich services were you interested in?Do you have a preferred Recovery Partners Consultant? Referrer DetailsNot applicable Same as Employer details provided Title*SelectDrMrMrsMsMissFirst Name*Last Name*Phone*Email* Comments Attach filesAttach File (file size limit 20mb)Accepted file types: doc, docx, odt, jpg, gif, png, pdf, Max. file size: 20 MB.CAPTCHAUntitledUntitledEmailThis field is for validation purposes and should be left unchanged. For an ‘ask us anything’ chat:1300 647 789 Let’s start a conversation! Our friendly support team are ready to assist you. Call us on 1300 OHS RTW (647 789) or email enquiries@rrp.com.au We welcome your enquiry FIRST NAME*LAST NAME*EMAIL* PhoneCompany NameHOW CAN WE HELP?*CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.