Menu Icon Search

Referral Forms

We are constantly adding to and updating this list. If there is something you would like to see included, please email us at practicesupport@ddwmphn.com.au and let us know.


Chronic Disease Referral Form (Formerly RPHS) Referred patients must utilise all other funding options prior to using Chronic Disease Program funding.
DVA Request This form should be used to: • request prior approval from DVA, where necessary, for treatment services and the supply of rehabilitation appliances; • refer directly to another provider where prior approval from DVA is not required; • request patient transport for travel to treatment services.
Gp Information Folder October 2017
ITC Referral Form - CCSS Integrated Team Care (ITC) General Practitioner Referral Form - Care Coordination and Supplementary Services (CCSS) Program
ITC Referral Form - Transport and Practical Assistance Integrated Team Care (ITC) Referral Form - Transport and Practical Assistance
Mental Health Client Consent Form Replaces ATAPS Consent Form
Mental Health Consent Information Sheet By signing the Mental Health Client Consent Form you consent to the information contained within this information sheet
Mental Health Referral Form Replaces ATAPS and MHRSSA Referral Forms
PFAS Claim Form Blood Tests Per- and Poly-fluoroalkyl Substances (PFAS) Claim Form - Pre and Post Blood Tests
PFAS Claim Form Mental Health Per- and Poly-fluoroalkyl Substances (PFAS) Claim Form - Psychological Therapies & Mental Health Services
PMHC MDS Mental Health Care Services This form is for new patients from 1 July 2017
Toowoomba Diabetes Service Referral Form Toowoomba Diabetes Service Referral Form - Credentialed Diabetes Educator (CDE) services, for the self-management of Diabetes
West Moreton - Medical Director - Referral Form Instructions Instructions for importing templates into Medical Director (PDF)
West Moreton - Best Practice - Referral Form instructions These are instructions for importing templates into Best Practice (PDF)
West Moreton - Best Practice Referral Form Best Practice Outpatient Referral Form (RTF)
West Moreton - Medical Director Outpatient Referral Form Medical Director Outpatient Referral Form Template(RTF)
West Moreton - ZedMed Outpatient Referral Form Zedmed Outpatient Referral Form (RTF)
Zostavax Vaccine Consent Form Zostavax Vaccine Consent Form

Icon Stay in the loop

Subscribe to our e-newsletter to stay up-to-date with news and information
affecting Health Care practitioners in the Darling Downs and West Moreton Regions: