Refer a Client

NOTICE Our online booking system is currently being updated. In the meantime, please email us at NSW@vhcc.au to arrange your hydrotherapy pool booking.

Submit a Referral

Complete this form to refer a participant to VHCC. We respond to all referrals within one business day.

Referrer First Name

Referrer Last Name

Organisation / Practice

Referrer Email

Referrer Phone

Referrer Role

Participant First Name

Participant Last Name

Participant Date of Birth

NDIS Number (if known)

Participant Location

Service Required

Support Needs & Goals

Urgency