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Making a Referral

Thank you for choosing Bloom Occupational Therapy.
 

Completing our referral form is the first step in connecting with our services. The details you provide help us understand the client’s needs, goals, and support requirements so we can ensure the right therapy pathway from the very beginning.

Referral Form

This form can be completed by individuals, family members, carers, or professionals (such as GPs, support coordinators, or allied health providers). It will ask for:

  • Referrer details (so we know who to contact if we need further information)

  • Client information (including contact details, diagnosis, and reason for referral)

  • Support needs (such as funding type, report timeframes, and any risks or concerns to be aware of)

  • Service agreement details (who should receive copies once signed)

  • Any additional information that will help us provide the right support

 

Once the referral form is submitted, our friendly team will review the information and be in touch to confirm the next steps.

You don’t need to have every detail perfect—just complete what you can, and we’ll guide you from there.

Birthday
Day
Month
Year

Is it ongoing therapy or reports (FCA,SIL,ILO)? Please include timeframe of report completion and reason for FCA report (if applicable).

Funding Type
Who should receive copies of the service agreement of signing?

Bloom Occupational Therapy

Ready to start your journey with Bloom? 

Submit a referral today and we will be in touch.

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