Make a Referral

REFERRAL FORM

Use this form to refer a worker case to Pinnacle Rehab. Click here for a printable PDF version.

To start services as quickly as possible we need the following details:

  • Client Details (Name, Contact Number, Suburb, Claim Number)
  • Employer Details (Company, Contact Person, Email Address, Contact Number)
  • Insurer Details (Company, Contact Person, Email Address or Contact Number)
  • Doctor Details (Practice, Contact Person, Contact Number)
  • Referrer Details (Company, Contact Person, Email Address, Contact Number)

If you have this information simply drag and drop the information below in file or image format.

Pinnacle Rehab have helped thousands of workers and employers each year, using a collaborative approach to injury prevention and rehabilitation. Call us now on 1300 591 438.

Pinnacle Rehab Pty Ltd, PO Box 1114Crows NestNSW 1585 - Phone: 1300 591 438 Email: admin@pinnaclerehab.com.au