Medicare and Private EPC Medicare and Private Patients Exercise Physiology Referral Form Please use this referral for EPC Medicare and Private patients. For WorkCover patients, please use our WorkCover form.Please fill out the referral form below: Please enable JavaScript in your browser to complete this form.Referral Type *MedicarePrivateName *FirstLastPatient DOB (dd/mm/yyyy)DiagnosisAdditional InformationPractitioner NameTitleTitleMrMrsMsDrPractitioner EmailPractitioner PhonePractice AddressSubmit Talk to one of our qualified Exercise Physiologists about how we can help you realise your goals. CONTACT US