Submit a request – Enriched Health Care Help Centre

Please choose your appropriate form below

Your email address

Enquiry Source

Where did you hear about Enriched Health Care?

Participant Name

Participant Address

Participant's residential address (street, suburb, postcode)

Participant Phone Number

Please provide mobile phone number where available. This ensures that your participant can be contacted during their time with us. Format: (0x) xxxx xxxx; Ex: 0450 480 308

Participant Date of Birth

DD/MM/YY

Insurer

Participant Claim Number

Participant's site of injury, condition or impairment

Accepted condition through claim and funding

Location

Do you have a carer?

(participant)

Participant's Carer's Name

Participant's Carer's Email

Participant's Carer's Phone Number

Do you have a GP?

(participant)

Participant's General Practitioner Name

Participant's General Practitioner's Medical Centre

Participant's General Practitioner's Phone Number

Participant's General Practitioner's Email

Please provide fax number if General Practitioner has no email

Do you have a specialist?

(participant)

Participant's Specialist Name

Participant's Specialist Type

eg: Orthopaedic Surgeon, Neurologist, Psychologist...

Participant's Specialist Phone Number

Participant's Specialist Email

Please provide fax number if specialist has no email

Do you have any other Health Care Professionals?

(participant)

Participant's Health Care Professional's Name

Participant's Health Care Professional's Type

eg: Physiotherapist, Occupational Therapist, Hand Therapist...

Participant's Health Care Professional's Company

Participant's Health Care Professional's Phone Number

Participant's Health Care Professional's Email

Do you have an Insurer Case Manager?

Insurer Case Manager - Name

Insurer Case Manager - Company

Insurer Case Manager - Email

Insurer Case Manager - Contact No:

Do you have a Rehabilitation Consultant?

(participant)

Participant's Rehabilitation Consultant Name

Participant's Rehabilitation Consultant Company

Participant's Rehabilitation Consultant Phone Number

Participant's Rehabilitation Consultant Email

Do you have any other relevant contacts?

Description

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.

Attachments

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