Referrals

Make a referral

GPs, paediatricians, schools, early childhood services, support coordinators and other professionals can refer clients aged up to 25 for:

Parent or carer? You can use the parent enquiry form instead.

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Fields marked with an asterisk are required.

Service requested

Select all that apply.

Speech Therapy Occupational Therapy Feeding Therapy Allied Health Assistant

Referrer information

Your name

Role and organisation

Phone

Child or client information

Full name

Date of birth

Funding

Parent or carer information

Parent or carer name

Phone

The parent or carer knows about and agrees to this referral.

Referral details

Reason for referral

Relevant notes

Referral letter or report (optional)

PDF or Word document, up to 5 MB.

Information in this form is sent securely to the Gold Star Therapy team and handled in line with our privacy policy.

Thank you for your referral