Refer to Us | Home Support Services

Refer to Us

To refer a patient to us, we offer two options to send a referral. You can simply click on our web form or complete our PDF referral form.

1. To use our web form, please click on the link below, fill out the required information and submit. You will receive a receipt of your referral shortly after.

The web form is the fastest way to refer to us. Based on your program selection the form will automatically hide any information not required making it easy to provide the detail we need which will result in faster referral processing and eligibility checks. One click submission will save you time, no longer needing to download, print, sign and email the form.

Web form


2. When using the PDF Referral form, please save the form to your computer and send via email as an attachment to

PDF Referral form


Please ensure you attach all supporting documentation to your referral including medication charts, wound care charts or allied health reports.

If required, please use our medication chart template. To use please download and save the file to your computer. Please print, complete and scan the chart and send via email as an attachment with the PDF Referral form.

Medication Chart template


If you require a supply of forms for the HSS folder on the ward, please contact our office or get in touch with your Hospital Liaison Officer.