Brief history/background: (send additional pages if needed)
Note to Referrers:
Please provide all necessary ACC details. There will be a “Private” fee will apply if there are no current ACC claim details provided. Patients will be charged $40 to complete a ACC32 forms for patients who require ongoing treatment. Patients who are sent for referral without current ACC funding will be billed as ‘Private’.
Thank you for your referral. A full report will be provided within 3 days of the consultation.