BetterHealth Riverton

GP Referral Form

Submit a referral for your patient to our allied health team. We aim to contact patients within 1 business day. For urgent referrals, please also call us directly.

0422 326 254 riverton@betterhealthgroup.au202 High Road, Riverton WA 6148

Referring Practitioner

Referring Doctor's Name*

Practice Name*

Phone*

Email*

Medicare Provider Number

Patient Details

Patient Full Name*

Date of Birth*

Patient Phone*

Patient Email

Referral Details

Service Requested*

Urgency*

Funding Type

Diagnosis / Presenting Condition*

Clinical Notes / Referral Reason*

Goals / Expected Outcomes

Contraindications / Precautions

I confirm that I have obtained the patient's consent to share their personal and clinical information with BetterHealth Riverton for the purpose of this referral. I understand this information will be used to arrange and deliver appropriate allied health care.

This form is transmitted securely. For urgent matters, please also call 0422 326 254 directly.