Treatment Form Referral Service

We will proceed with this instruction on the basis of Joint Instruction under the Rehabilitation Code 2015. This means we will simultaneously disclose subsequent clinical reports to the claimant’s solicitor. Please confirm you agree to this.

We will contact the claimant’s solicitor to obtain agreement to proceed with this instruction as Joint Instruction under the Rehabilitation Code 2015. This means we will simultaneously disclose subsequent clinical reports to the claimant’s solicitor. Please confirm you agree to this.

Please advise why you believe this instruction should not proceed as Joint Instruction under the Rehabilitation Code 2015

Treatment / Investigation only

Claimant Details

Insurer Details

Claimant Solicitor Details

Employer Details

Additional Information

Treatment / Investigation only

Claimant Details

Insurer Details

Claimant Solicitor Details

Employer Details

Additional Information

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