Discovery Phase

Discovery Phase

This is your first step to ensuring You and Prydes Support are a good fit for each other.
Who is filling out this form?*
If you are unsure one which one to choose, feel free to give us a call on 1300 240 844.

What is your Legal Name*

PrefixFirst NameMiddle NameLast Name
What is the Participants Legal Name*

PrefixFirst NameMiddle NameLast Name
What is your Preferred Name
What is the Participants Preferred Name
What is your Gender
What is the Participants Gender
What are your Pronouns
What are the Participants Pronouns
What is your Phone Number*
Please enter a valid phone number.
What is the Participants Phone Number
Please enter a valid phone number.
What is your Email
example@example.com
What is the Participants Email
example@example.com
What is your Suburb*
This is the suburb of the location you would like to receive supports.
What is the Participants Suburb*
This is the suburb of the location you would like to receive supports.
Do you have a Support Coordinator?*

YesNo
Support Coordinator details

First NameLast Name
Support Coordinator details
Please enter a valid phone number.
Support Coordinator details
example@example.com
Is their a partent, legal guardian or plan representaive?*

YesNo
Parent Guardian Name*

First NameLast Name
What is the relationship to the participant?
What type of Support are you looking for? *
E.G. In-Home care, Community Access, SIL, or other?
Worker Preference. E.G. Cis Male, Cis Female, Non-Binary, Non-CIS Female, ect.
What do you wish to achieve from engaging with Prydes Support?
What are your primary diagnoses?
What is your ideal start date with Prydes Support?

DayMonthYear
Date
What is your ideal shift structure? E.G. Days, times, length of shift. Example, Monday 9am to 4pm.*
Do you have any concerns you wish to raise before engaging with us as a Service Provider?
Do you have any Registered Supports, E.G. Positive Behaviour Support Plan, Medication Management, ect. Please list below
How are you invoices paid? *
By submitting the form, you acknowledge that Prydes Support will take steps to make contact with the participant and/or guardian/plan representative and Support Coordinator.

If you do not wish for this to happen, please do not submit this form and contact the office at 1300 240 844 or email info@prydessupport.com
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