Employers Referral Form

Insurers Referral Form

Host Employers Referral Form

REFERRALS

We have 3 easy ways to request assistance.  We will contact you within 4 hours to arrange the service you require.  

Online

Click the applicables box below, complete and submit the form.

Employers
Insurers
Host Employers

Email

Email your own referral form to:

referrals@momentum4.com.au

Phone or Fax

Please call on 1300 109 662 to discuss your needs.

You can fax us on 07 3102 8566.

Momentum4 provides occupational health, injury prevention and rehabilitation services in Queensland.  

General Enquiries

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1300 109 662

07 3102 8566

admin@momentum4.com.au

Unit 10/696 Sandgate Road
Clayfield, Queensland 4011

Referrals