Our experienced Allied Health team are here to help you achieve your goals and flourish in every part of your life.  Please allow up to 15 minutes to complete our referral form below.  There is also an option to save information as you progress and return at a later time (this is located at the bottom of the form).

If you have any queries at all please don't hesitate to contact us on 07 31391202 or admin@mytherapycrew.com.au

Upon hitting submit you will receive an emailed copy of the form submitted to us.


Personal Details

This should be the name of the person requiring therapy
Please kindly enter in the following format for mobiles 0000 000 000 and 00 0000 0000 for landlines.
The number should be in the following format for mobiles 0000 000 000 and the following for landlines 00 0000 0000.


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Preferred Communication


Medications

Services Offered

Please provide detail if referral is for an FCA (ie does the client wish to move, do they need more funding, or do they wish to know areas for potential skill development etc.)
Please kindly check your NDIS plan when completing this information
Would you consider your non preferred therapist for a short period of time if your preferred therapist is unavailable?

Diagnoses


Payment of My Services


NDIS Information

What is PACE – stands for Participant/Provider Alternative Cloud Environment – is the NDIA’s new customer relationship management system (CRM). Most big organisations use a CRM to record, analyse and store customer data, and to communicate with their customers. PACE is: - designed to make it easier for NDIA staff and partners to do their job, work the same way everywhere in Australia, and make consistent decisions and intended to improve the participant and provider experience
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Positive Behaviour Support (PBS)

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Historical Information


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Consent


We will always ask the client or the client’s guardian verbally if they are happy for us to take a photo during the session. Photos are used for a range of reasons including, but not limited to – internal training, demonstrations and social media and marketing purposes. Clients have the right to refuse this at any time. However, if you are happy for My Therapy Crew to take and use photos of the client please tick the consent box.



Staff and Student Shadowing

Our core values  - dependable, always learning, nurturing and contributing, support our oranisational vision 'To make a positive impact in the lives of our clients and crew'.  

As part of our contributing value we are passionate about our profession and are committed to supportingAllied Health professionals to have a positive impact. We empower ourcrew to share their knowledge and skill.

To support this value we provide opportunities to new staff joining My Therapy Crew to accompany our staff into therapy appointments.  These same opportunities are provided to students who are assigned to My Therapy Crew in order to complete their professional placement as part of their university studies.  We commonly refer to this as 'shadowing'.