• Initial Enquiry and Capacity Form

    Take 2 minutes to share what you’re looking for. Our team will review your needs and get back to you within 24–48 hours to confirm our current availability or waitlist options.

  • Referrer Details

  • Format: 0000000000.
  • What is your relationship to the participant?*

  • About the Participant

    This section focuses purely on the person who will be receiving the care.
  • Date of Birth*
     - -
  • Gender Identity*
  • Format: 0000000000.

  • Cultural & Communication Needs

  • Do you identify as Aboriginal or Torres Strait Islander?
  • Will the participant require an interpreter for our meetings?*

  • Supports and Availability

  • What services are you looking for? (select all that apply)*

  • When are the supports required? (Please select day and specific start and end time for each day required.)

  • Participant Goals & Diagnosis

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  • Support Worker Preferences

  • Gender preference*

  • Other Stakeholders

  • Are there any other key stakeholders or organisations involved in your care?*

  • Funding & NDIS Details

  • How is the participant's support funded?*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Plan Start Date*
     - -
  • Plan End Date*
     - -

  • If you require Behaviour Supports, please provide details of the available funding.

  • To help our accounts team draft a perfectly balanced Schedule of Supports within the participant's budget allocation, please provide the funding details below:
  • Which Funding Category will be used for Behaviour Support?

  • Funding for all other supports.

  • To help our accounts team draft a perfectly balanced Schedule of Supports within the participant's budget allocation, please provide the funding details below:
  • Are there any regular locked-in costs already drawing from this specific pool? (e.g., an ongoing counselor or other therapist)?
  • Period

  • Thank you for completing this referral.

  • Please Note: The information you provide helps Racham Care assess our current team capacity. If we have immediate capacity, we will fast-track you to our full intake process! If we match your needs but don't have a spot today, we will offer you a place on our priority waitlist.
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