Patient referral form

Lymphoma Australia welcomes you to refer all of your lymphoma/CLL patients or their carers to the Lymphoma Care Nurse team. Patients can be referred at any point, from diagnosis, during treatment, after treatment or relapsed/refractory lymphoma/CLL.

On this page:

Patient Referral Form

How to refer patients

  1. The referral form can either be downloaded or printed from the link on this page. Let us know if you prefer hard copies that we can send to you.
  2. Healthcare professionals can refer a patient by completing their details on the form.
  3. You can email back to the team:
  4. The Lymphoma Care Nurses will triage and contact the patient or carer to best support them
  5. Resources and information can be sent to the referee as required


The referral form has been created for healthcare professionals to connect patients and their loved ones to Lymphoma Australia. The earlier patients can be referred to us, we can:

  • Ensure they have received enough information about their subtype, treatment and supportive care options. We are able to provide age appropriate information too.
  • Patients and their carers will know that we are here for additional support when and if needed.
  • They know about our Lymphoma Nurse Support Line or can email us if they need additional specialist support or information
  • They can learn about the online support group Lymphoma Down Under for peer support with over 2,000 other patients and carers from across Australia
  • They can sign up for our regular newsletters to keep them updated on the latest lymphoma announcements about treatment, education and events organised by Lymphoma Australia.
  • They know where to receive reliable information from our website, throughout their lymphoma journey when they need it. People’s needs change over time and knowing where to find information is important.

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