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MCMP Referral Form

Referral Forms

Independent Pharmacist

Need a Pharmacy Review or other IMM Intervention?

Complete our online referral form, attach relevant supporting documents and hit submit. Alternatively, you can download our referral form and email us at 

Have a question first?

Contact our office to speak with a team member or Pharmacist.


Medicinal Cannabis Management Program

In response to the growing demand for insurers to provide funding for medicinal cannabis treatments over the past year, we at IMM are pleased to introduce a groundbreaking medicinal cannabis management program.


This 12-week initiative is designed to efficiently address requests for medicinal cannabis, particularly in cases where an Independent Medical Examination (IME) or Medical Specialist Panel (MSP) has recommended a trial of medicinal cannabis as a reasonably necessary treatment.

What documents are useful to assist a Review?

Recent treating doctors reports/letters, recent IME/IMC reports, Pharmacy invoices/accounts statements, WorkCover certificate of fitness/capacity, injury management plans, medication lists, and any documents that you think are relevant to the review.

We will always contact you if we think additional information would assist our Review.

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