Patient Referrals

Refer a patient to HCQP’s Detox & Withdrawal Hospital Program or HCQ’s Residential Rehabilitation Program using the online form below, once submitted you’ll receive an email with a ‘Doctor’s Referral Letter’ to be filled out and returned via email or fax

Email: re*******@************ld.com.au
Phone: 1300 856 847
Fax: (07) 3547 8482

Your details
Name*
Practice*
Email address (optional)

If entered, a confirmation email address will be sent to this address.
Phone number*
Please include area code.
Patient Name*
Patient Phone*
This field is hidden when viewing the form
Referral submitted timestamp
Consent*
- I have consent to make this referral
- Patient did not provide consent
What is consent? Consent includes having personal information stored by The Hader Clinic QLD and consent to share information back with (the referrer) about the referral.