top of page

Make a Referral

 

Refer someone who may benefit from care and support at home from Assisted Medicare Services Limited (AMS). We welcome referrals from healthcare professionals, social workers, organisations, family members and individuals.
 

Please provide the information below so our team can review the referral and contact you to discuss the next steps.


Important: This form is not monitored for emergencies. If someone is in immediate danger, call 999. For urgent referrals, contact AMS directly by telephone.

Section 1: About the referrer

Who is making this referral?

Section 2: Details of the person being referred

Who should AMS contact first?
Does the person know about this referral?
Yes
No
Not sure

Section 3: Support required

What type of support is required?
When is support needed?
How often is support expected to be needed?

Section 4: Urgency and relevant risks

Is this referral urgent?
Yes
No
Are there any immediate concerns about the person's safety or wellbeing?

Urgent referrals and emergencies

This form is not monitored for emergencies or immediate risks. If someone is in immediate danger, call 999. For urgent care enquiries, contact AMS directly by telephone using our published contact number. Do not rely on this form for an immediate response.

Section 5: Consent and privacy

Has the person being referred agreed to this referral and to AMS contacting them?

I confirm that I have read the AMS Privacy Policy and understand that the information provided will be used to review and respond to this referral. I confirm that I am authorised to provide the information submitted, where applicable.

  • Facebook
bottom of page