Independent Rehabilitation Services has been providing expert in-home neuro care for over 25 years.

Our core services are Occupational Therapy, Physiotherapy and Speech Pathology for neurological conditions. We provide support exclusively to adults in their homes and communities across Greater Melbourne and Mornington Peninsula.

• Referrals can be made by support coordinators, a treating professional, a family member, clients themselves or anyone involved in care
• Complete our online referral form below
• We review the referral within 5 business days and will be in touch if there’s any further information we require

Need help

Our friendly intake team is happy to discuss your intervention needs between our business hours of 8.30am – 5pm (Melbourne time)

• Call 03 9885 2533

• Email referral@independent-rehab.com.au
• Make a general enquiry via our contact form

More information

• Referral information

• Current availability

• Our service areas

• FAQs

• NDIS

• Aged care

• Privately funded clients 

Please complete the form below and note compulsory fields are marked with a red asterisk.

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Client Details

Please provide information about the person you are referring for our services.

Client Name *

First

Last

Client Date Of Birth *

Client Address *

Address Line 1

City

State / Province / Region

Postal Code

Client Phone Number *

Client Email *

Client Accommodation Type *Select accommodation typeAged CareMedium Term Accommodation (MTA)Private homeSupported Disability Accommodation (SDA)Other

Next of Kin / Alternative Contact

Next of Kin / Alternative Contact Name *

First

Last

Next of Kin / Alternative Contact Relationship to Client *Select relationship to clientSpouseParentDaughterSonSiblingGrandsonGranddaughterGuardianOther

Next of Kin / Alternative Contact Phone Number *

Next of Kin / Alternative Contact Email *

Referrer Details

Who should we contact regarding this referral?

Referrer Name *

First

Last

Referrer Phone Number *

Referrer Email *

Email

Confirm Email

What is your relationship to the client? *Select your relationship to the clientI am the clientGuardianNext of kinSupport CoordinatorOther

Referral Information

Please provide details about the services you require.

Which services are you referring for? *

• Occupational Therapy
• Physiotherapy
• Speech Pathology

Diagnosis/Conditions *

Please note as we are a community based neurological rehabilitation service, we are not able to accept referrals where the primary diagnosis is any of the following: Intellectual Disability, Autism Spectrum Disorder, or Psychosocial.

Please select the services you require.

Occupational Therapy *

• Initial Assessment
• TAC Assessment
• Cognitive Rehab
• Driving Assessment
• Equipment Assessment
• Functional Capacity Assessment
• Home Modifications
• Upper Limb Therapy
• Other

Physiotherapy *

• Initial Assessment
• Equipment
• Home Exercise Program
• Pain Management
• Other

Speech Pathology *

• Initial Assessment
• Communication
• Equipment
• Swallowing Assessment
• Other

Funding

Please provide information about how the client's services will be funded.

Funding Body *

• Aged Care - Home Care Package
• NDIS
• Private
• TAC
• WorkSafe Victoria
• Other

Fees for Privately Funded Clients

If an external funding body is not involved in your care, treatment will fall under our private rates.

Participant Number *

Claim Number *

Registered Age Care Provider Company/Organisation Name *

Who is the Case Manager at the Registered Aged Care Provider? *

First

Last

Email *

Phone Number *

Who should we email invoices to? *

First

Last

Email *

Plan Details

Please provide information about the NDIS participant's plan.

Did the participant's plan start on or after 19/05/2025? *

• Yes
• No

What are the participant's plan start and end dates?

Start *

End *

Please provide details about the participant's funding periods.

Occupational Therapy funding periods

Date *

End *

Amount *

Physiotherapy funding periods

Date *

End *

Amount *

Speech Pathology funding periods

Date *

End *

Amount *

Please attach the participant's current NDIS plan.

Drag & Drop Files, Choose Files to Upload

Max file size 20Mb.

List the participant's NDIS funding allocated for each service referred to. Please note we require a minimum of 15 hours allocated to each discipline. *

List the client's TAC funding allocated for each service referred to. Please note we require a minimum of 10 hours therapy and 4 hours travel allocated to each discipline. *

Risk

Are there any behavioural or other risks we should know about? *

• Yes
• No
• Not sure

Which of the following risks are present? *

• Behaviours of concern (including verbal and/or physical aggression)
• Forensic history
• History of drug or alcohol abuse
• History of violence
• Mental health concerns
• Weapons or firearms on premises
• Other

Please provide further information about the risks below. *

Other Information

Please share any goals related to this referral

Please add any files related to your referral such as discharge summary, medical or specialist reports, behaviour plans etc

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Is there any other relevant information about your referral you would like to provide?

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