Referral Form

This form can be used for self referrals or to refer someone else.

Please note: Privacy and confidentiality are of utmost importance to us. The referral information you provide will be used solely for the purpose of bookings. This information will not be retained for any other purpose and will only be accessed by authorised personnel in accordance with Royal Rehab’s privacy policy.

Referral Cairns

Online referral form

1
Introduction
2
Participant details
3
Primary contact / carer / nominee details
4
Referral details
5
Risk Identification
6
Other details

Ready to get started on your Royal Rehab LifeWorks journey?

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In the spirit of reconciliation, Royal Rehab acknowledges the Traditional Custodians of Country throughout Australia and their connections to land, sea, and community. We pay our respects to their Elders past, present and future and we extend our respects to all Aboriginal and Torres Strait Island peoples.

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