Private Referral

Submit a Referral

If you are an allied health provider or GP wanting to refer a private patient for exercise physiology services patients can contact Rehabilitation in Motion directly to make a booking or you can provide a letter of referral or submit online referral form below.

Online Referral Form

Client Details:

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Client's Name:

Phone:

Reason for Referral:

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 musculoskeletal rehabilitation management of persisting pain post-operative exercise rehabilitation hydrotherapy chronic fatigue or cancer related fatigue management chronic disease health management other

Comments/diagnosis:

Referrers details:

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Referred by (name): (required)*

Contact Phone Number:

Contact Email: (required)*

I would prefer ongoing communication by:
 phone in writing

Type in code