Online Referral Form

If you’re helping someone who may benefit from extra support to maintain their independence, we’re here to assist.

Refer Now

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Simply fill out the form and our dedicated team will take care of the rest!

✔️ We can offer information or help with a referral to My Aged Care or the NDIA.

✔️ We’ll keep you updated regarding any important updates or outcomes.

"*" indicates required fields

1. Referrer Details

First Name*

Last Name*

Role*

Organisation*

Phone Number*

Email*

2. Patient or Client Details

First Name*

Last Name*

Date of Birth*

Postcode*

State*

Phone Number*

3. Referral Reason & Context

Message*

4. Services Requested (select all that apply)

What services are you looking for?*

Help navigating My Aged Care or NDIS

Home and Community Care

Home Care Packages (My Aged Care)

Accommodation (SDA or SIL)

Mental Health EAP for Businesses

Attendant Care Services (icare)

Private Services

6. Consent and Permissions

Please select all that apply*

I confirm that I have obtained the patient’s or client’s consent for Leora Healthcare to contact them.

I would like to receive updates on the progress of this referral.

This field is for validation purposes and should be left unchanged.

Home & Community Care

NDIS Funding Eligibility

Accommodation: SIL & SDA

NDIS Pricing Arrangements

icare Attendant Care Services

Home Care Packages

Private Self-Funded Care

Home Care Package Eligibility

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For Individuals

For Therapists

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