Submit Referral | Appetite For Nutrition

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Please provide the full details of the client and referrer. We will provide the option to complete the service agreement now to help fast-track your dietitian allocation.

Not sure if you have enought information? Take a look at our referral checklist here.

Or get in touch with our team and we can assist you with your enquiry.

info@appetitefornutrition.com.au
0491 169 399

Book telehealth

Submit enquiry

Refer Someone

This form can be used for all referrals including NDIS, Medicare, DVA, Paying Privately, Worksafe, TAC, and Aged Care Packages. It can be completed by the Client, a Health Professionals, Family Members and Support Staff.

1Step 1

2Step 2

3Step 3

Who is this referral for?(Required)

Myself

Family Member

Client _{(from health professional/support coordinator)}

Other

Referrer details:

Referrer’s Full Name(Required)

First

Email Address(Required)

Phone Number(Required)

Has this client been seen by Appetite for Nutrition previously?(Required)

Service Location :

Where would you like to see a dietitian?(Required)

Telehealth

Home Visit

Either

Home Visit Safety Information :

Type of residence

Lives alone

Lives with family

Supported Disability Accommodation

Other

Will anyone else be present?

Yes

Are there behaviours of concern?

Yes

Are there pets in the home?

Yes

Are there weapons or firearms in the home?

Yes

Is the environment safe for visiting health professionals?

Yes

Is there mobile phone coverage?

Yes

Have there been safety incidents with previous health workers?

Yes

Client Details

Client’s Full Name(Required)

Gender

Date of Birth(Required)

DD slash MM slash YYYY

Home Address*(Required)

Street Address Suburb Postcode

Key Person Details:

(Contact required for bookings)

Key Persons Name(Required)

Relationship to Client(Required)

Key Persons Email(Required)

Key Persons Phone Number(Required)

Preferred contact method?

Phone

Either

Further Patient Information

Dietitian Preference(Required)

Female

Male

No Preference

Request specific dietitian

Dietitian name

Please tell us why you're seeing a dietitian, including any relevant medical history and the participant’s disability.(Required)

Is there anything else we should be aware of, for example: specific days/time for appointments, or any other factors that may impact allocating a dietitian?(Required)

Funding Information :

How will the service be funded?(Required)

Private Paying

Home Care Package / My Aged Care

NDIS

Medicare

WorkSafe

TAC

DVA

Other

Select NDIS Plan(Required)

Funding Details :

Invoicing Email Address(Required)

Provider Organisation(Required)

Funding available(Required)

Invoicing Email(Required)

NDIS Number(Required)

Funding Amount(Required)

Plan End Date(Required)

DD slash MM slash YYYY

Plan Start Date(Required)

DD slash MM slash YYYY

Support Category(Required)

Plan Manager

Organisation Name(Required)

Email(Required)

Support Coordinator

Name(Required)

Email(Required)

Phone(Required)

Funding available for dietitian services

Does funding include report writing?(Required)

End-of-plan report due date

DD slash MM slash YYYY

NDIS goals

TAC Claim Number(Required)

Date of Accident(Required)

DD slash MM slash YYYY

Injury Details(Required)

Case Manager :

Name(Required)

First

Phone(Required)

Email(Required)

Funding available :

Does funding include report writing?(Required)

Invoice Email(Required)

DVA Card Number(Required)

DVA Card Expiry(Required)

DVA Card Type(Required)

Invoicing Email Address(Required)

Upload Supporting Documents :

Upload any relevant documents if available.

Max. file size: 2 GB.

Examples: NDIS Plan, Medicare Care Plan, GP Referral, DVA Referral Letter, Blood Test Results OR email to info@appetitefornutrition.com.au

Service Agreement :

Would you like to complete the service agreement now?(Required)

Yes – Complete now

No – Send via email

Would you like to complete the service agreement now?(Required)

Yes – Complete now

No – Send via email

Service Agreement Contact Details

Name(Required)

First

Email(Required)

Phone(Required)

See full service agreement

Confirm Acknowledge(Required)

I confirm the information provided is accurate & I consent to Appetite for Nutrition contacting relevant providers regarding this referral(Required)

see full service agreement

Please Read Before Signing

This agreement outlines the nutrition services provided by Appetite for Nutrition – Accredited Practising Dietitians.

For NDIS participants, this document serves as your official NDIS Service Agreement and is valid for the duration of your plan dates.

Dietitian Services Overview

We support you to achieve your nutrition goals through:

Nutrition assessments, education, and advice
Meal planning and supplement support
Cooking sessions, supermarket tours, and food-related activities
Goal setting and ongoing support

Our Commitment to You

We aim to deliver respectful, flexible, and high-quality care by:

Offering appointments that suit your schedule
Providing choice and control in your care
Involving you in decision-making
Communicating openly and respectfully
Providing at least 2 business days’ notice for changes
Protecting your privacy and securely managing your records
Complying with relevant laws (NDIS Act, Australian Consumer Law)
Charging fees according to our schedule and issuing timely invoices

Your Commitment to Us

To help us support you effectively, we ask that you:

Share your goals and preferred support format
Notify us of any changes to your health, funding, or plan status
Treat staff respectfully and communicate concerns
Provide at least 2 business days’ notice for cancellations or changes
Pay invoices within 14 days (if applicable)
Understand unpaid invoices may delay future appointments
Avoid disruptive behaviour, alcohol, or smoking during sessions

For Home Visit Clients

Inform us about pets, other attendees, or safety concerns
Ensure the home environment is safe and hazard-free
You may end a session at any time if you feel uncomfortable

Emergencies & Privacy

Staff may leave the premises or contact emergency services if required
Your information is used only to support your care and managed according to privacy laws
Information may be shared with your care team, NDIA, or relevant bodies where required for service delivery or by law

Use of AI for Transcription

To assist with documentation and accuracy, we may use secure AI-powered transcription tools during consultations.

These tools convert spoken dialogue into written notes to assist clinical documentation
Transcriptions are stored securely and treated as confidential health information
Transcription is used for clinical note-taking only
You may opt out at any time by notifying your dietitian or admin team

Ending Services

Either party may end this agreement with 2 weeks’ notice.

Appetite for Nutrition may also end the agreement in cases of:

Non-payment
Unsafe conduct
Repeated cancellations

Feedback & Complaints

Email: info@appetitefornutrition.com.au
Phone: 0491 169 399
NDIS participants may escalate unresolved complaints to the
NDIS Quality & Safeguards Commission – 1800 035 544

Services & Fees Summary

Effective July 2025

Home Visit Appointment Duration

All home visit appointments are scheduled for a minimum of 60 minutes, unless otherwise negotiated in advance with the dietitian.

NDIS & DSOA

Direct services billed at $188.99 per hour in line with the NDIS price guide.

Initial Consultation

60-minute appointment
30 minutes non face-to-face service time

Total billed: 90 minutes – $283.50

Review Consultation

60-minute appointment
10 minutes non face-to-face service time

Total billed: 70 minutes – $220.50

Supermarket / Cooking / Food Sessions

60-minute appointment
10 minutes non face-to-face service time

Total billed: 70 minutes – $220.50

Non face-to-face time may include documentation, preparation of resources, and care coordination.

Indirect Services

Reports, letters, care team meetings and coordination are billed according to time spent.

Travel

$47.25 – $94.50

(Maximum 60 minutes round-trip, capped in line with NDIS guidelines)

My Aged Care (Home Care Packages)

Direct services: $220 per hour

Minimum appointment times:

Initial – 1 hour
Review – 30 minutes

Indirect services (reports, communication, care coordination) billed according to time spent.

Travel: $55 – $220 depending on one-way travel time.

TAC (Transport Accident Commission)

No gap payable by the client

Long consultation (30 min): $96.99
Prolonged consultation (45–60 min): $193.99
Reports: $126.58
Travel: $38.36 - $193.99

DVA (Department of Veterans’ Affairs)

No gap payable by the client

Initial consultation (45 min): $127.80
Review consultation (25 min): $76.65

Travel:

$80 (≤30 minutes)
$102.30 (≤60 minutes)

Administrative Services & Care Team Meetings

Administrative services may occur between appointments and may include:

Reviewing notes
Documentation
Preparing resources
Communicating with care teams or support coordinators

Care team meetings (including case conferences or multidisciplinary meetings) are billed as direct dietitian services, with a minimum charge of 30 minutes.

All administrative and meeting time billed will be documented and charged according to relevant funding guidelines.

Cancellation & Payment Policy

This policy applies to all scheduled appointments, including consultations and care team meetings.

Late arrivals >15 minutes = 100% cancellation fee
Rescheduling more than twice = 50% fee
Cancellation or rescheduling with <2 business days’ notice = 100% cancellation fee
Same-day cancellations (including rescheduling) incur a 100% fee
Outstanding payments must be settled before new appointments can be booked
Clients must ensure funding is current and available
Unpaid invoices may be referred to debt collection (30% recovery fee)

Client Acknowledgement

By signing below, you confirm that:

(Required)

You understand and accept the service, fee, and cancellation policy(Required)

(Required)

You accept your responsibilities as a client(Required)

(Required)

You consent to the use and sharing of your information to support your care(Required)

(Required)

You agree to the terms of this agreement until funding ends or services cease(Required)

For NDIS participants, this also confirms:

Consent(Required)

This document serves as your official NDIS Service Agreement with Appetite for Nutrition(Required)

Consent(Required)

Your NDIS plan dates and funding information are accurate(Required)

Name(Required)

Date(Required)

DD slash MM slash YYYY

Signature(Required)

Please prove you are human by selecting the Key.