First name only at this stage. Please do not include an NDIS number, diagnosis, medication or clinical history.
Broad adult-life goal areas Choose the areas the goals sit in. Specific targets are set with the participant, not here.
Broad support requirement A sentence or two: the level of assistance usually needed, anything that affects safety in the community, and what a good worker match would look like. Keep it non-clinical.
Why we are asking, and what happens to it
We collect referrer contact details and minimal participant information so we can assess preliminary fit and reply to you. The consent confirmation above is recorded with the referral.
If the referral progresses, further information is collected directly with the participant and their family through a secure intake step - not through this form.
Full detail is in our privacy collection notice and privacy policy . Please do not include diagnoses, medical history or NDIS numbers in any free-text box.