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WORKCOVER REFERRAL FORM

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REFERRER DETAILS

Referrer Name

Referrer Phone Number

Referrer Email

Referrer Company

Goals of Referral

CLIENT DETAILS

Full Name

Date of Birth

Address

Phone Number

Email

Claim Number

INJURY DETAILS

Diagnosis

Date of Injury

Other Relevant Details

EMPLOYER DETAILS

Company Name

Contact Name

Phone Number

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INSURER DETAILS

Insurer Company Name

Case Manager Name

Direct Phone Number

Case Manager Email

TREATING DR DETAILS

Name

Practice

Prefered Location (Please Select One)

Clinic: ATUNE Health Centre 52 Ada Street, Cardiff, NSW 2285

Community Based (Home Visit/Local Gym/Local Hydrotherapy)

Telehealth/Online

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CONTACT US

Newcastle Clinics

Cardiff

Atune Health Centre

52 Ada Street, Cardiff, NSW 2285

Belmont

Atune Health Centre

452 Pacific Hwy, Belmont NSW 2280

(By Appointment Only)

Charlestown

The Rainbow Clinic

(Paediatrics)

Suite 7, Level 2, 3 Hopetoun Street
Charlestown, NSW, 2290

PHONE

(02) 40 752 750

FAX

(02) 40 275 753

HOURS

Cardiff

Monday: 8:00 am - 6 pm

Tuesday: 7:30 am - 6:30 pm

Wednesday: 7:30 am - 6:30 pm

Thursday: 7:30 am - 6:30 pm

Friday: 7:30 am - 5:30 pm

Saturday: CLOSED

Sunday: CLOSED

Belmont

By Appointment Only

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