DiverseyCare

General Referral Form

Essential Information

Anything you want us to know, i.e I need after school hours, female therapist or I have spoke to your staff on the phone etc.
I confirm that I am the service user, or an authorised parent, guardian, or representative, and I have consent to complete this referral and share relevant personal information with Diversey Care.

Terms and conditions for the Free Initial Consultation (20 minutes)

– The free initial assessment is available only to new clients or to existing clients who have a new condition.

– This session includes a free assessment, diagnosis, and treatment plan.

– At the end of the assessment, you will be informed and given the option to continue with paid treatment.

– If you choose to receive treatment after your assessment, you will be charged for these services.

– This offer cannot be combined with any other promotions. It is limited to one per client and cannot be exchanged for cash or products. It is available to new clients or existing clients with a new injury.

– Information on standard consultation fees is available at the practice.