No referral form required
Patients can self refer and no formal referral is needed for our services. This form simply gets your patient into the right hands faster and tells us what you have already ruled out.
Refer a patient
Send a referral in two minutes
For GPs, ENT specialists, audiologists, psychologists and allied health colleagues. Fill in the form below, or email it through. We contact your patient directly within two business days and report the findings back to you in writing.
We do the chasing
Your patient is contacted directly to book. The referral does not sit waiting for them to call us and it does not come back to your desk.
You get a written report
Findings, severity scores, recommended pathway and anything clinically relevant, including where we think ENT input is warranted.
Referral form
Everything we need, nothing we do not
Your details, the patient’s details, and a brief clinical summary. There is space to upload an audiogram, ENT report, or a signed D904 for veteran patients. It takes about two minutes.
Prefer to email?
Send a referral letter to admin@tinnitusrelief.com.au with the patient's name and best contact number. Attach the audiogram if you have one.
To discuss a patient before referring, call 1300 148 657 and ask for the clinical team.
- Contact within two business days
- Telehealth available Australia wide
- DVA paperwork and approvals handled by us
- Written report back to the referrer
Patient information submitted here is used only to arrange care and is handled in line with our privacy policy. If a patient has sudden onset tinnitus, unilateral tinnitus, pulsatile tinnitus or sudden hearing loss, please manage as urgent through your usual pathway rather than waiting on this referral.
Open the form in a new tab if you would rather bookmark it or send it to a colleague.
After you refer
What happens, and when
1
Within two business days
We contact your patient to book their comprehensive assessment and confirm whether they will be seen in clinic or by Telehealth.
2
At the assessment
Validated severity scoring, sound tolerance screening and full history, plus diagnostic audiometry at our Sunshine Coast clinic or arranged with a clinic near you.
3
Report back to you
Emailed to the address you gave above, usually within a week of the appointment, with findings, scores and the recommended pathway.
4
Progress updates
Score changes at review points through the program, so you can see whether it is working without chasing us for it.
About the form
Questions about referring
How long does the form take?
About two minutes. Only your details and the patient's contact details are mandatory. The clinical fields help us prepare but leave them blank if you do not have them to hand.
What happens after I submit it?
We contact your patient directly within two business days to book their assessment, so the referral does not stall waiting for them to call us.
Can I send the audiogram separately?
Yes. Tick the box on the form and email it to admin@tinnitusrelief.com.au, or attach it to a referral letter if you would rather send one.
What if the patient is significantly distressed?
Tick the prioritise box and we will move them up. If a patient has sudden onset, unilateral or pulsatile tinnitus, or sudden hearing loss, please manage that as urgent through your usual pathway rather than waiting on this referral.
Is patient consent required?
Yes. The form asks you to confirm the patient is aware of the referral and consents to being contacted.