Are you a GP, Medical Practitioner, Nursing or Allied Health Professional?

You can refer your patients to the Get Healthy Service by completing the form below.  All people with cancer and in survivorship must be referred to the cancer support program.

What happens next?

Your patient will be contacted by the Get Healthy Service within 5 working days.

Not a health professional?

Sign yourself up on the Get Started page now


* Mandatory 



Consent confirmation: By submitting this completed form, the health professional/medical practitioner confirms that the participant has consented to this information being sent to the Get Healthy Information and Coaching Service, and consents for the Service to contact them (verbal consent is sufficient).

Completion of the inclusion and exclusion criteria are required for patients in pre-treatment and active treatment. This is not required for patients in survivorship/post-treatment.

Inclusion/Exclusion Criteria

Unfortunately, your patient is not currently eligible for the Get Healthy Cancer Support program because they have/meet one or more of the exclusion criteria.

Please review the inclusion and exclusion criteria and consider referring your patient to the Get Healthy Service once criteria are met

Patient's Details

Referral Source

If any of the above is unstable or untreated, please consider deferring the referral until appropriate for participation in the service.

Health Professional Details

If you wish, the service will send you updates on your patient's progress, sent at enrolment, mid-point and graduation. Patients will need to consent to this on their registration call. Feedback letters can be provided via email.

Are you going to refer again?
Select the option below and your referral details will be remembered on this device for next time.

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