Referrals to the PHN Service

PHN Service Referral form

Referral Form - Public Health Nursing Service.


GP's are able to refer via ERMS.

Instructions for using writeable version referral form:

  1. Click the file to open in Adobe Acrobat reader OR right-click>save target as>save the file to your computer

  2. Complete all fields on the referral form

  3. Note: when signing the form if you do not have a digital ID simply add your name in the signature field and leave the other digital ID field empty

  4. On completing the information on the form, save the form - if possible, when doing this type the patients' name in the filename so that it can easily be referenced

  5. Email the PDF file as an attachment to


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Page last reviewed: 23 March 2018