Hospital medical, pharmacy and allied health referral Diabetes Australia – Tasmania We welcome referrals from hospital medical staff, pharmacists, allied health practitioners and community/case care workers from anywhere in Tasmania. Our clinical, COACH and group programs are FREE for people with, or at risk of diabetes. Individual consultations are offered via telehealth, video as well as face to face. With the patient’s consent, please complete the referral form below and our customer service team will contact the patient and talk to them about how we can help. FREE Services & Programs Diabetes Educator and Dietitian Clinics Nurse Practitioner Clinics Group Educational Sessions (DESMOND) Telephone health coaching – The COACH Program Healthy Living Events Type 1 Diabetes youth activities View our full services and programs here. Hospital medical, pharmacy and allied health referral – Tasmania "*" indicates required fields Referring PersonReferrer organisation*RHH Neurology TeamOtherReferrer organisationReferrer full name*Referrer position*Referrer phone*Referrer email* Reason for referring*Client DetailsFirst name*Surname*Date of birth*GenderGenderMaleFemaleOtherStreet name and number*Suburb*Postcode*Phone number*Email* Client’s diagnosisDiagnosis (select appropriate tick box)* At risk of type 2 diabetes (eligible for COACH only) At risk of stroke (eligible for COACH only) At risk of CVD (eligible for COACH only) Pre-diabetes (eligible for COACH only) Type 2 (eligible for clinics, COACH or NDSS groups) Type 1 diabetes, gestational diabetes and other can be referred to NDSS groups. Eligibility for diabetes educator and dietitian clinics are not met. Family doctor/GP name*General practice name*General practice phone number*Endocrinologist name (if applicable)Client ConsentDiabetes Tasmania will only contact this client if they have provided consent for this referral. Does the client consent to being contacted by Diabetes Australia? Consent*Choose oneYesNoA Diabetes Tasmania health professional will discuss this referral with the client prior to booking an appointment. Diabetes Tasmania offers one on one appointments with a Diabetes Educator or Accredited Practising Dietitian, a free telephone based health coaching service and group education programs to help your client better manage their diabetes.
