Referral to Maurice Blackburn from Australian Hand Therapy Association

AHTA member number *

Name *

Contact number *

Email address *

Do you require information related to a work related injury?

Employer/Worksite *

Do you require information related to a road accident injury

Do you require information related to an injury in a public place or from a faulty product?

Do you require information related to employment law*?

Do you require information related to employment contracts***?

Do you require information related to a superannuation or insurance claim? e.g. Life, trauma, income protection, disability, mortgage protection, other

Do you require information related to a will dispute or estate planning?

Have you advised the member of this referral to Maurice Blackburn and do you reasonably believe the member will not object to being contacted? *

Yes
No

Referral to Maurice Blackburn from Australian Hand Therapy Association

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