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Participant's Details
Participant's name
*
Full Name
Participant's E-mail Address
*
example@example.com
Participant's Phone Number
Phone Number
Gender
Male
Female
N/A
NDIS Number
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Your Details
Your Name
*
Full Name
Your Email Address
*
example@example.com
Your Phone Number
Phone Number
Company (optional)
Tell us about you
I'm a Local Area Coordinator
I'm from Brotherhood of St. Laurence
I'm an NDIS Provider
I'm a Support Coordinator
I'm a Participant referring another participant
Other
Has the Participant given you the consent to refer them?
*
Yes
No
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Attach documents (Eg. NDIS Plan, OT reports, SOP reports etc.)
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Frequency & Forecasting (Service Type - Price/hr) Optional
Daily
Weekly
Fortnightly
Three-weekly
Monthly
As Required
Transport
Required?
Total
Hours
Total Price
(Excluding Travel)
Household Cleaning - $51.81
Gardening - $50.87
Support Worker(Community Engagement /Independent Living Support) Level 1 - $62.17
Support Worker(Community Engagement /Independent Living Support) Level 2 - $67.28
Support Worker(Assistance with Self-Care Activities) Level 1 - $62.17
Support Worker(Assistance with Self-Care Activities) Level 2 - $67.28
Community Nursing(Div. 1) Delivery of Supports - $110.4
Community Nursing(Div. 2) Delivery of Supports - $89.17
High Intensity Daily Personal Activities(HIA)- Level 3 - $67.28
Skill Development & Capacity Building: Increased Community Participation - $70.87
Individual Skill Development: Training - $62.17
Level 1 Therapy Assistant - $56.16
Level 2 Therapy Assistant - $86.79
Support Coordination: Level 2 - $100.14
Psychosocial Recovery Coaching (Weekdays) - $93.34
Counsellor (Employment Related Assessment and Counselling) - $193.99
Psychologist (Assessment, Recommendation and Training) - $214.41
Assessment Recommendation Therapy or Training - Teacher-
- $193.99
STA And Assistance (Inc. Respite) - 1:1 - Weekday
- $1,928.20
Additional Information
Contact Type
Referral (website)
Contact Source
Referral (website)
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