• Client Intake Form

    Client Intake Form

    NDIS Disability Services

  • Participant Details

    Please provide all relevant details of the participant.
  • Date of Birth:*
     / /
  • NDIS Plan Type*
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  • Browse Files
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  • Supports & Services

    please select supports and assistance required
  • Services Required:*
  • Supported Accommodation Supports:

  • Person Centred Information

    please provide specific details of the participants so we can provide suitable supports.
  • Please describe participants mobility:*
  • Assistance required in personal care:*

  • Shifts

    Please provide information regrading shift so we can organise staffing requirements
  • Shift days and times
  • Preferred Start Date:
     - -

  • Participant's Primary Contact Details

    please enter details of next of kin/ responsible personnel / legal guardian of the participant.

  • Consent

    Please read below and provide consent for us to provide services to the participant.

  • We work closely with other agencies to coordinate the best support for you. This means your informed consent for the sharing of information will be sought and respected in all situations unless:

    • we are obliged by law to disclose your information regardless of consent or otherwise;
    • it is unreasonable or impracticable to gain consent or consent has been refused; and
    • the disclosure is reasonably necessary to prevent or lessen a serious threat to the life, health or safety of a person or group of people
  • Please tick*
  • Do you give Paramount Care Consent to provide support and services to the participant as selected above:*
  • Should be Empty: