Refer a Client

Referring a client for case management support?
We’re here to help.

Looking for case management support?
We’re here to help.

If you’re a professional looking to refer a client for case management, please complete the form below with as much detail as possible.

This will help us understand your client’s needs and respond appropriately. We will be in touch within 1 business day to discuss the next steps.

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Enquiring party details

Name(Required)

First Last

Company

Email(Required)

Phone

Client details

Client's Age

Please enter a number from 0 to 100.

Client's Postcode

Details of injury

When the injury occured

Inpatient / Outpatient status

Please provide any other details that you feel would help with the referral.

Consent(Required)

I confirm that I have obtained appropriate consent from the individual being referred to share their personal information with Unite Professionals. I understand that the details provided in this form will be used solely for the purpose of assessing the referral and delivering relevant case management services, in line with Unite Professionals’ Privacy Policy.