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The following referral templates are available to download:

Best Practice Referral Template

Zedmed Referral Template

Medical Director Referral Template

St Vincent's Referral Template (Specialist Clinics) 

Victorian Statewide Referral Form (VSRF) - available in Medical Director

Victorian Statewide Referral Form (VSRF) + Urology

Victorian Statewide Referral Form (VSRF) + Osteoarthritis Hip and Knee

Pathology request form



The St. Vincent's Rehabilitation, Aged Care and Aged Psychiatry Referral Form is the referral template for the following services:

  • Aged Care Assessment Service (ACAS)
  • Aged Psychiatry Assessment and Treatment Team (APATT)
  • Aged Care Specialist Clinics (Falls & Balance; Continence; Cognitive, Dementia & Memory Service (CDAMS); Geriatric Medicine)
  • Community Rehab Centres
  • Geriatric Evaluation & Management (GEM) Unit  
  • Home Based Allied Health Services (Podiatry, Physio, OT, Speech, Dietetics)



Other forms include:



41 Victoria Parade, Fitzroy VIC 3065, Australia. Phone: (03) 9288 2211