For referrals and intakes please contact:
03 9525 1300
If you are a health professional and would like to refer to us, please fill in this Referral Form.
Client Family Name*
Client Given Names*
Client Date Of Birth (dd/mm/yyyy)*
Client Home Address*
Client Contact Phone Number*
Client Country of Birth*
Is the client of Aboriginal or Torres Straight Islander origin?*
Does the client have a refugee status?*
Does the client require an interpreter?*
If yes, please state preferred language
Is the client living in insecure housing?*
Client Medicare Number* (Enter NA if not available)
Please give details of the client's current GP (GP name, Practice name, Address, Phone)*
Does the client hold any of the following concession cards?*
---Pension ConcessionDisability SupportHealth Care CardNot stated/unknown
Please outline your reason for referral*
Please tick below if you have an Assessment and/or Care Plan and would be happy for Star Health to contact you to obtain a copy. Alternatively, you can attach them below.
Please attach an Assessment and/or a Care Plan if available
Does the client give consent to a referral to Star Health?*
Please prove you are human by selecting the Key.