+61 (03) 9455 0822

How to Refer A Patient

Banksia Palliative Care Service Inc.

How to Refer A Patient

Anyone can make a referral, providing the person requiring the care, agrees.  Please telephone us or download a referral form.


Banksia’s services are available to clients of all ages who have a progressive terminal illness and are living in the Cities of Banyule, Whittlesea and the Shire of Nillumbik.  Care and support is offered to the whole family. Clients can be discharged or readmitted as appropriate.


The services offered by Banksia are at no cost to clients within our service area. There may be associated costs depending on your individual needs, for example Royal District Nursing Services and some equipment costs.

Banksia can help to facilitate the supply of equipment via a hire company, however, Banksia does not directly supply equipment to clients.   Unfortunately, Banksia cannot receive disused equipment from clients or families.

How To Make A Referral

Step One

Contact Banksia and ask for the INTAKE WORKER to discuss your referral.

Phone 03 94569744


Step Two

Download and complete Referral Forms

(1)  Contact Banksia and ask for the INTAKE NURSE Coordinator to discuss your referral. Phone 03 94569744 during normal business hours.

(2)  Download and complete Referral Forms (Health Professionals)

There are (5) five forms that are to be completed for Banksias’ Referral Process.  The following documents are available for downloading in PDF format.

Click to Download these forms

1. Referral Cover Sheet and Acknowledgement
2. Consent to Share Information
3. Consumer Information
4. Palliative Care Supplementary Information
5. Summary and Referral Information


Step Three

Fax Referral Forms to Banksia on 03 94553599.

(Health Professionals: Please note that emails cannot be accepted due to client confidentiality).