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Referrers

Refer a patient

For GPs, case managers, support coordinators and self-referrers. Only the essentials — we'll call your patient within one business day to complete intake.

Download referral form (PDF)

Two-page A4 · print, complete and email to admin@blacktownphysioclinic.com.au

Patient

Please provide at least one way to reach the patient.

Referrer (optional — helpful if we need to clarify anything)
Requested service
Add clinical notes (optional)
Sending documents

Online attachments are not available yet, because secure private file storage hasn't been switched on for this site. Please email documents to admin@blacktownphysioclinic.com.au or call reception and we'll arrange a secure transfer.

Authority & consent

Privacy collection notice

Blacktown Physioclinic collects the information on this form to contact the patient and arrange care. Information is handled under the Australian Privacy Principles and the Health Records and Information Privacy Act (NSW), and is only accessible to authorised staff. You can request access or correction by emailing admin@blacktownphysioclinic.com.au.

The referral record is stored in Australia. A copy of the referral details is also emailed to the clinic's own address so staff can act on it quickly; email providers may process or store that message outside Australia.

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