Make a Referral

KINNECT Referral Form

Refer a worker for workplace rehabilitation, injury prevention, occupational medicine or psychological support. Choose a category to see only the relevant services and questions.

KINNECT Referral Form

Choose the support needed, then complete the relevant details. Required fields are marked *.

Save on this device for 7 days. Attachments are never stored.

1. Support needed

Workplace RehabilitationRecovery, capacity and practical return-to-work support.Injury PreventionTraining, assessments and workplace programs that reduce injury risk.Occupational MedicineSpecialist medical assessment and advice for workplace health decisions.Psychological ServicesPsychological assessment, counselling and work-focused recovery support.

3. About you

What best describes you? *OrganisationPrefixFirst name *Last name *Job titleEmail *Mobile *

5. Referral detailsWhat would you like KINNECT to assist with? *Briefly tell us what you would like us to assess, provide or help achieve.Additional information

6. Supporting documentsSupporting documents — upload up to five relevant documents (5 MB each)Upload any relevant medical certificates, reports, job descriptions, test results or other supporting documents.

KINNECT uses these details to assess and deliver this referral. Only provide health information that is necessary and that you are authorised to share.

I have read the privacy notice and am authorised to provide these details. *What is 2 + 2? *