Referral form No.1

Together, we’re all working to create a happier, healthier life for all.

Make a referral

Maintaining a full-time team of crisis and health management experts can be costly and unnecessary during stable times. That’s where HCML’s Crisis Consultants come in. Ready to act swiftly, they provide remote or on-site support, offering their specialized expertise to help you navigate even the most challenging and complex situations.

Get Started

Nationwide Onsite Health Surveillance and Assessments

Our onsite health surveillance service is nationwide and includes the following assessments:

Audiometry (noise)
Fork-lift truck medicals
Spirometry (respiratory)
HAVS (hand arm vibration)
Skin

Confined spaces
Working at heights
Face fit testing
Isocyanates
On-employment questionnaires

Make a Referral

Online referral for instructing parties.

Send us a referral through our fully secure and encrypted online referral form. You’ll receive a confirmation email with the details you submit. We aim to respond in 1 working day.

Injured Person’s Details:

Title *

Name *

Postcode *

Address *

Date of birth *

Gender *

Home Contact Number *

Mobile Contact Number

Email *

Date of accident *

Injury Site and Description (Optional)

Referrer (Your) Details:

Name *

Company *

File Reference *

Postcode *

Address *

Contact Number *

Email *

**Are you the funding party*?**

Company

File Reference

Name

Postcode

Address

Contact Number

Are you the claimant’s legal representative?*

Company

File Reference

Name

Postcode

Address

Contact Number

Select a Service:

Treatment Only:
Facilitation of a documented medicolegal or other clinical recommendation for treatment, consultations, surgery or diagnostics.

Triage:
Rehab Code compliant triage assessment and treatment for minor MSK injuries.

Desktop Immediate Needs Assessment (INA):
A remote based desktop assessment that provides a fully costed rehabilitation plan and MDT treatment approach for moderately complex injuries and / or those requiring support with a return to vocation.

Multitrack Immediate Needs Assessment (INA):
An in-person assessment that provides a fully costed rehabilitation plan and MDT treatment approach for complex injuries and / or those requiring support with a return to vocation.

Catastrophic Immediate Needs Assessment (INA):
An in-person assessment that provides a fully costed rehabilitation plan and MDT treatment approach for life changing injuries – ABI, spinal cord, major limb amputation, paediatrics.

Please call me to discuss.

Additional instructions or documents

Choose File