HMR / DMMR Referral

Refer a Patient for a Home Medicines Review

Use this form to submit a referral or enquiry for a Home Medicines Review. Once submitted, our team will allocate an accredited pharmacist and follow up with the referring practice or pharmacy.

Your Name

Your Email

Phone Number

Referral Type

Preferred Contact Method

Referral Notes / Reason for Referral

I confirm the participant / patient has provided consent for this referral and agrees to be contacted for a Home Medicines Review.

By submitting this form you confirm the patient/participant has provided informed consent to be contacted for a Home Medicines Review.