Occupational Therapy Referral Form

Please ensure that this is YOUR (the referrer's) email address. This will be the email address that all preliminary email will be sent to. You have the right to withdraw your consent for contact at any time by getting in touch with Benefact management (hello@benefact.com.au or 02 8330 6761).

You are able to select more than one option here - it just helps this form adjust to fit your needs! By default, we will initially contact the person completing this form unless otherwise specified.

Participant Details

We're currently UNABLE to accept new referrals for clients that are under the age of 16 years. 

We really wish we could, but we're firm believers in sticking to practising within our scope/expertise. 

This means that we're dedicated to ensuring that all of our clients receive the care and support they deserve

If you're struggling to find a paediatric OT, we'd recommend checking out the Occupational Therapy Australia 'Find an OT' website to get in touch an OT with the skills and experience that your little one needs!  

CISGENDER = your gender identity corresponds with your sex assigned at birth / TRANSGENDER = your gender identity/gender expression that differs from the sex that you were assigned at birth

Please check that this address is correct, including unit number/s or building name/s if required. 

Please edit accordingly if there are incorrect or missing details.


Referrer Details (Person Making the Referral)

Please select -NOT LISTED- if you are unable to locate your organisation


Reason For Referral



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Please note that you are also able to send any relevant documentation to hello@benefact.com.au. We will never share your information with any third parties without your explicit and informed consent.

NDIS Details

Please select -NOT LISTED- if you are unable to find your plan manager

Benefact Occupational Therapy recommends that you are able to allocate ≥ 25 hours of funding if you are a new client.  This figure is inclusive of: 

  • Initial assessment + travel time, incl. KMs as per NDIS price guide (travel time waived if assessment is completed via telehealth. Note that environmental assessment/ergonomic assessments are only able to be completed in person)

  • OT functional assessment (inclusive of the administration, interpretation, and presentation of additional standardised NDIA preferred outcome measures/assessments as clinically indicated). Further information regarding the nature and scope of our clinical expertise, assessments, and scope are available on our website

  • Comprehensive OT Care Needs Report & Intake Summary, including complete NDIS recommendations (across all categories) and clinical reasoning

  • Ongoing Care Management and liaison with your existing care team and the NDIA as required


We are also able to bill from your flexible CORE funding if you are a Plan or Self Managed NDIS participant. We will always seek your informed consent prior to doing so.

As always, feel free to get in touch with us via hello@benefact.com.au if you have any questions. 


Post referral submission, we will be able to provide you with a detailed quote for services if requested - just ask!

Participant Representative/Alternative Contact Details



Agreement and Consent


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