Where did you hear about Enriched Health Care?
Please use format (0x) xxxx xxxx; Ex: 0450 480 308
Have you referred to Enriched Health Care before?
Please complete this if your organisation requires a purchase order number for payment of invoices
PLEASE DO NOT ENTER A REFERRER EMAIL OR ALTERNATE EMAIL INTO THIS FIELD AS IT WILL AFFECT YOUR PARTICIPANT'S INFORMATION. Enriched Health Care requires an email address for the participant. We will use this email address to set the participant up in our system and to communicate with the participant. Participants include Job Seekers, Injured Workers, NDIS participants, Aged Care patients, athletes, and all other patients.
Please provide mobile phone number where available. This ensures that your participant can be contacted during their time with us.
Please use the format: 0xxxxx xxxx; Ex: 0450480308
Note: If you cannot provide a phone number type "N/A" in this field instead.
Please enter any additional details of your request and attach any relevant documents. A member of our support team will respond to your request as soon as possible.