Client Onboarding Form

  • Client Onboarding Form

  • Are you filling in the form for yourself or on behalf of someone?*
  • How will our services be funded?*
  • Please select the services you are seeking:
  • Your relationship to the Client

  • Client Details

  •  / /
  •  - -
  • Gender
  • Phone Number type
  • How would you like to be contacted for future correspondence?

  • Service and Funding Details

  • How is the plan funding managed?*

  • Thank you for considering our services. Unfortunately, as a registered NDIS provider, our current registration does not permit us to support clients who are under 9 years of age and agency-managed. We understand how important it is to find the right support, and we regret that we’re unable to assist in this instance. 

  •  - -
  •  - -
  • How would you like to enter NDIS goals
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Does the client have a plan nominee?*

  • *A plan nominee is someone formally appointed by the NDIA to make decisions and manage NDIS funds on the client's behalf

  • Service Information and Budget Allocation

  • What services do you require?*
  • Please specify your preferred location for the sessions.
  • Please specify your preferred location for the sessions.
  • Please specify your preferred location for the sessions.
    • PAGE BREAK TO KEEP NEXT BUTTON VISIBLE - NOT VISIBLE ON FORM 

  • Therapy Preparation

    Please note that the information requested in this section is for preparation purposes only and is not required to be fully completed. It is perfectly okay to leave any section blank or provide only what you feel comfortable with. You can update this information at any time during your therapy journey.
  • Are you able to answer the below therapy preparation questions?*
  • Accommodation type

  • Safety, Well-Being, and Support Screening

    This section collects vital information to ensure a safe and supportive environment for clients and staff. It helps us understand specific needs and challenges that may affect care. Your responses, treated confidentially, are key to tailoring our services for the best outcomes.
  • Are you able to answer questions regarding home safety for the participant?*
  • Have you indicated that your sessions are at home ?*
  • Will there be animals present in the household during the session*
  • Will there be an unrestrained dog present during the session?
  • Has there been any history of physical, verbal abuse, discrimination, or inappropriate behavior towards providers by the client or household members?*
  • Are there any household or environmental concerns that could impact our care provision or safety? (e.g. dangerous household members, substance use or objects at the property, etc.)*
  • Are there any personal concerns or considerations that we should know to tailor our support effectively? (e.g. housing instability, domestic violence, family violence, child protection involvement, etc.)*

  • Key contacts

  • Who is best to contact for appointments*

  • Primary Contact

    Can be client, support coordinator, family member etc.
  • Has the primary contact's information already been entered?*
  • Is the Primary Contact:

  • Emergency Contact

  • Has the emergency contact's information already been entered?*
  • Is the Emergency Contact:
  • How did you find us ?
  • Should be Empty: