Make a referral

Getting started is simple

Services are accessible without a medical or GP referral. You can be referred by a family member, friend, caregiver or health professional.

How would you like to refer?

Choose a pathway

Fastest

Complete online

Fill in our secure online form below. Submissions are received instantly and a confirmation is sent to your email.

Instant submission
Confirmation email sent automatically
No software required

Complete online form

Download PDF form

Download our fillable PDF referral form, complete it in your PDF viewer, then email it back to us.

Works offline
Can be printed and filled by hand
Email to referrals@dailydoing.com.au

Download PDF form

Online option

Online referral form

We welcome referrals from anyone — family members, carers, support coordinators, health professionals, or the individual themselves.

Participant information

First name *

Last name *

Date of birth

Phone number *

Email address A confirmation will be sent here if provided

Residential address

Disability / condition

Reason for referral *

Support person / next of kin

Please provide details of a support person or next of kin where applicable.

Name

Relationship to client

Phone number

Funding information

Funding body *

Referrer information

A confirmation of this referral will be sent to the referrer email below. If left blank, the confirmation will be sent to the participant's email address instead.

Referrer name *

Relationship to client *

Referrer phone *

Referrer email

Risk assessment

Our therapist may be visiting the home environment. Please select any of the following that may apply to the participant or any household members — this helps us to prepare and ensure a safe visit.

Aggressive or challenging behaviour Drug or alcohol use in the household Weapons present in the household Dogs or animals that may pose a risk Infectious disease or contamination risk Hoarding or cluttered environment Smoking in the property Family violence concerns Other (please specify above)

Additional information

Anything else important to note e.g. interpreter required, preferred contact times, access requirements

Getting started is simple

Choose a pathway

Complete online

Download PDF form

Online referral form

Participant information

Support person / next of kin

Funding information

Referrer information

Risk assessment

Additional information

Thank you — your referral has been received

Unable to submit referral