IMPORTANT:

If you are an individual wanting to refer yourself or a friend/family member, please note that this form needs to be filled in by an ACC Sensitive Claims Service (SCS) Lead Provider. Please send your Lead Provider the information about Revive and ask them to refer you. If you have any questions or issues, please let us know (office@adventurespecialties.co.nz att: Anneke)

The following form is designed to be filled in by an ACC Lead Provider and their ACC Sensitive Claims Service (SCS) client, collarboratively.