My Patient(s)

*note: as per program rules, only GPs, Pain or Palliative Medicines Specialists, Physicians and Psychiatrists can currently activate referrals for this service.

Does your client already have a preferred, credentialed pharmacist that they'd like to perform this service?

No - I would like a credentialed pharmacist to perform this service

Yes - What is their name and contact details so we can collaborate with them?

Does the client want a copy of their HMR report sent to their community pharmacy?

No

Yes

*note: as per program rules, only GPs, Pain or Palliative Medicines Specialists, Physicians and Psychiatrists can currently activate referrals for this service.

Facility name*

Facility postcode*

Preferred appointment datetime

Appointment delivery method

Other*

Referral Forms

Contacts

Your Details

Patient(s) Details

I would like to enter care recipient(s) details one at a time

I would like to upload details for patient(s) who are all under the care of the above prescriber in bulk

Patient 1