NB: Please be advised that the ABIS program is now closed. Referrals for the breathlessness management service will still be accepted. However, patient will need to pay for the service privately or use other available funding such as Homecare Package or NDIS.

IMPORTANT NOTE: ABIS teaches patients non-pharmacological strategies that will help them feel more in control of breathlessness and reduce its impact on activities of daily living.

ABIS does NOT provide medical management of underlying health conditions.

IMPORTANT NOTE ABOUT WAIT TIMES: The current wait time for an initial appointment is approximately 4 weeks, with wait times being updated regularly.

ABIS Patient Referral Form

First Name *

Last Name *

DOB *

Phone Number *

Email Address (put referer email address if patient doesn't have one) *

Patient home address *

Postcode *

Referer details (name and contact details) *

Referer Email (put your email if referring yourself) *

Emergency contact name and details: *

Eligibility criteria

Please upload the patients's health summary and medication list here *

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Breathlessness Impact

ABIS is suited to people with ≥ Grade 2 on the modified Medical Research Council (mMRC) scale.

Some patients struggle to understand ‘strenuous’ so may find it easier if you start at Grade 4 and work backwards. GP's please ask the patients this and record their response to ensure you are sending eligible patients.

Grade 4: I am too breathless to leave the house or I am breathless when dressingGrade 3: I stop for breath after walking about 100 yards or after a few minutes on level groundGrade 2: On level ground, I walk slower than people of the same age because of breathlessness, or I have to stop for breath when walking at my own pace on the levelGrade 1: I get short of breath when hurrying on level ground or walking up a slight hillGrade 0: I only get breathless with strenuous exercise

Activities of Daily Living (ADL's)

“What has your breathlessness made you less able to do in everyday life that bothers you”?

Rephrase the question as needed and give the following infographic as examples:

“What has your breathlessness made you less able to do in everyday life that bothers you”? *

Risks to our team:

These are questions we have to ask to ensure the saftey of our team, participants/clients and patients. Please note any risks in the box below. Please consider these questions carefully.

Is there anything you would like to tell us regarding access to your house, parking, etc?

Will the client and the practitioner be the only people present during treatment?

Will all animals be prevented access to the front of the property or the parts where the practitioner will be? If NO, what animals will be present, and do they pose any risk to the practitioner?

Will everyone in the property refrain from smoking, drinking alcohol or using substances during the visit?

Does anyone in the property have history of actual or threatened violent/aggressive behaviour?

Are there weapons in the home?

Is there a work area in the property where the practitioner can safely place equipment and work?

Is there stable Mobile phone service/coverage?

Is there any risk of infection or illness? (covid or flu within the last 14 days)

Are there any behaviour trigers we need to be aware of? If so is there a behaviour plan in place?

Are there any cultural considerations you would like us to be aware of?

Any other risks we need to be aware of?

Please note any risks here relative to the questions above. Please write NO risks if none exist *

For security please complete the check below *