Physiotherapy
referee report.
A referee with direct knowledge of the clinician’s work completes this report to support their experience claims.
At least one completed report is required. Each referee should confirm only the work they can substantiate; further reports may be requested to cover other roles or periods. A report supports moderator review and does not automatically approve membership or determine a percentage score.
1. Clinician and referee details
Clinician’s full professional name and assessment/application reference. Referee’s name, role, organisation, professional registration (if applicable), work email and work phone.
2. Relationship and direct knowledge
How do you know the clinician? State whether you supervised, managed or worked alongside them; the organisation, dates and how frequently you observed their work. Declare any personal, family, financial or other potential conflict of interest.
3. Roles, dates and workload
Confirm only the roles and dates you can substantiate: job title, workplace, start/end dates, hours or FTE and proportion of work involving neurological rehabilitation. Distinguish direct observation from information supplied by the applicant.
4. Clinical settings and responsibilities
Describe observed responsibilities in acute/public hospital care, dedicated neurological rehabilitation, community care and transition home, as relevant. Explain the level of independence, supervision and complexity of the work you observed.
5. MND experience, if observed
Describe your direct knowledge of their MND work, including setting, responsibilities and approximate exposure. If you did not observe MND work, state “not observed”. Do not include patient identifiers or records.
6. Communication and professional practice
Give brief de-identified examples of multidisciplinary communication, handover, recognising limits and escalating concerns. Describe strengths and any development or supervision needs you directly observed.
7. Claims supported and limitations
Identify the work experience claims you can confirm, any discrepancies and anything you cannot verify. Do you consider the report a fair account of the clinician’s experience within the period you observed? Explain any reservations.
8. Declaration and permission
I confirm this report reflects my direct knowledge to the best of my ability, with limitations and conflicts disclosed. I consent to it being provided to Neuro Clinician Network moderator for application review and to being contacted to verify it. Referee signature and date:
Applicant: Upload the completed, signed PDF in the clinician portal under Referee report. Obtain the referee’s permission before sharing their details. Referee reports and contact details are not published on your profile.