First, let us know a little bit about you.
Who is the support for?
*
The support is for me
The support is for someone else
Your full name
*
First Name
Last Name
Date of birth
*
/
Day
/
Month
Year
Gender
*
Male
Female
Other
Your contact number
*
Email address
*
example@example.com
Address
*
Mailing Address
Street Address Line 2
City
State
Postcode
Emergency Contact
*
First Name
Last Name
Emergency Number
*
-
Area Code
Phone Number
Referred by
Known allergies, if any
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Next
Save
Now tell us about the type of funding & support required.
In this section, we will ask you some questions relating to your NDIS plan. It’d be great if you could have it handy to make the registration process faster. If you don’t have it with you, it’s ok too, you can always let us know at a later stage.
Type of Funding
*
NDIS
Private
NDIS number
Support level ratio
Please Select
1:1
1:2
1:3
1:4
Desired service start date
/
Day
/
Month
Year
Date
Desired service end date
/
Day
/
Month
Year
Date
Upload you NDIS plan, if possible
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Cultural or lifestyle requests
Goals to achieve with the plan
Please verify that you are human
*
Save
Submit
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