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Referral
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Health Professional Referral Form

Please complete the referral form below and press submit. One of our Cancer Care Nurses will be in touch with your patient. Please note that self-referrals and urgent requests for additional support is welcome by calling 07 4032 0820

Health Professional Details

First Name *

Last Name *

Occupation *

*Health Centre/Hospital name/Organisation *

Email *

Phone *

How did you find us?

Has the patient consented to this referral? *YesNo

Patient Details

First Name *

Last Name *

Gender *

Street Address *

City

State/Territory

Postal Code

Phone *

Email Address *

Is the request for a patient or a carer/support person

*Cancer Type *

Treatment PhaseDiagnosisTreatmentSurvivorshipPalliative CareCarer/Support Person

Support requestedNursing SupportGeneral PractitionerExercise PhysiologistPhysiotherapistLymphoedema MassageOncology MassageSocio-Emotional SupportGroup Exercise Classes (i.e. Yoga, Pilates, Breathwork, Gym, Circuit Style Classes, Other)

Additional Information

AttachmentsTo assist with the provision of appropriate care, please attach any relevant supporting documentation. This may include a health summary, relevant imaging or investigation results, or a GP Chronic Condition Management Plan (e.g., Exercise Physiology or Physiotherapy).

No file chosen

Please do not fill in this field.

Newsletter

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Stay connected with COUCH. Join our newsletter for updates, stories, and ways to support people living with cancer in Cairns.

FAQs

How do I become a client?

Becoming a client at COUCH Cancer Hub NQ is simple. You don’t need a medical referral — anyone impacted by cancer (patients, carers, or loved ones) can reach out directly.

To get started:

Contact our team – Call us on (07) 4032 0820 or send an email to admin@couch.org.au
Initial appointment – Our Cancer Care Nurse will contact you to discuss your needs and book your first appointment.
Personalised plan – Together, we’ll create a tailored plan to support your physical, emotional, and practical wellbeing through cancer.

We offer a range of allied health services, classes, and wellbeing programs designed to help you feel supported and stay strong before, during, and after treatment.

Do I need a referral?

No, you don’t need a referral to access COUCH Cancer Hub NQ. Anyone impacted by cancer — at any stage of their diagnosis and regardless of the length of time since diagnosis or treatment — can contact us directly to access our services and programs. This includes people living with cancer, carers and immediate family members.

Referrals from your GP, specialist, or other health professionals are always welcome, especially if you’re already receiving treatment or support elsewhere. Our team will work alongside your existing care providers to ensure you receive coordinated, evidence-based care.

To get started, call (07) 4032 0820 or email admin@couch.org.au to connect with our Cancer Care Nurse.

Is there a fee to access the services?

COUCH Cancer Hub NQ operates as a mixed-billing hub, with fees varying depending on the service, class, or program you choose.

Some services may be bulk billed, while others include a small out-of-pocket fee to help us continue providing high-quality, sustainable care. In some cases, you may also be eligible for a Medicare, private health, or DVA rebate, depending on the service and your personal circumstances.

To learn more about costs, visit the individual service or class page you’re interested in for current pricing and eligibility details.

How can I support COUCH?

There are many ways to support COUCH Cancer Hub NQ and help us continue providing vital care for people living with cancer in Far North Queensland.

You can:

Donate – Every dollar helps us deliver evidence-based health, wellbeing, and cancer support services.
Fundraise – Host a community event, morning tea, or workplace fundraiser and make a local impact.
Partner with us – Businesses can enhance their community connection through sponsorship or workplace giving.
Volunteer – Give your time, skills, or energy to help create a welcoming space for clients and families.

No matter how you choose to help, your support makes a real difference to local people impacted by cancer.

👉 Learn more or get involved by visiting our the Support Us tab at the top of this website, or calling (07) 4032 0820.

Stand with locals facing cancer — give today.

Donate

Our Advocate, Visionary and Legacy Partners

Address: 100 – 114 Reservoir Road, Manoora, Cairns
Postal: PO Box 332, Edge Hill QLD 4870
Opening Hours: 8:30 am – 4:30 pm Weekdays

Email: admin@couch.org.au
Phone: 07 4032 0820
Fax: 07 4032 0498

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We acknowledge the Gimuy Walubara Yidinji and Yirrganydji Peoples as the Traditional Custodians of the land and waters of Cairns. We pay our respects to Elders past and present, and extend that respect to all Aboriginal and Torres Strait Islander Peoples.

This website is supported by funding from Northern Queensland Primary Health Network (NQPHN) through the Australian Government’s PHN Program.

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