Make a ReferralReferral 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. Drop files here or Can you please type some brief details below to ensure we have accurate information to begin services.*Referrer DetailsReferrer Contact Person First Last Referrer RoleReferrer OrganisationPhoneEmail Client DetailsClient Name First Last Client PhoneClient SuburbClaim NumberEmployer DetailsEmployer Contact Person First Last Employer OrganisationPhoneEmail Agent / Insurer DetailsAre the Agent/Insurer details the same as the Referrer details?YesNoContact NameCompany NamePhoneEmail Team NumberRegionSydneyParramattaNewcastleWollongongTamworthCentral CoastOtherTreating Doctor DetailsName First Last PhoneEmailThis field is for validation purposes and should be left unchanged. 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.