Referral form

Refer someone to us

Three short steps. When you send it, a real person reads it - then we call you to talk it through before anything else happens.

3 short steps Nothing is final until we've spoken

Your full name

Agency or role (if any)

Your phone

Your email (if you'd like a copy)

Participant's full name

Date of birth (if known) For example, 14 3 1986

Best contact number (theirs, or a carer's)

Lives with (if known)

Street address (if known)

Suburb

Postcode

NDIS number (if known) 9 digits, starts with 43 - it's on the NDIS plan. Fine to leave blank; we can sort it later.

How is the plan managed? (if known)

NDIA-managed Plan-managed Self-managed Not sure

Does the participant identify as: (optional) We ask so we can offer culturally safe support - it never affects access to services.

Aboriginal Torres Strait Islander

Their disability and what support might help

Check your answers

Nothing is sent yet - change anything you like first.

We only use these details to follow up this referral - nothing else, no mailing lists.

Thank you. Here's what happens next: