July 2026 Intake Registration
Secure your place for our upcoming July intake. Please complete this form if you are an interested participant, family member, or a Support Coordinator registering a client for our 100% virtual capacity-building services.
Who is completing this form?
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The Participant (or a family member/guardian)
A Support Coordinator / Plan Manager referring a client
Support Coordinator Details
Name
*
First Name
Last Name
Organisation/Agency
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Participant Information
Participant's Name
*
First Name
Last Name
Participant's Email Address
*
example@example.com
Participant's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Participant's Suburb & State
*
How is the NDIS plan or support package managed?
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Plan-Managed NDIS
Self-Managed NDIS
Private / Self-Funding
NDIA-Managed (Agency-Managed) *Note: We are a private practice and cannot accept Agency funding directly*
Which of our programs are you interested in accessing? (Select all that apply)
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Psychosocial Support & Coaching ($105.43/hr)
Mentoring Programs ($80.06/hr)
Vocational & Employment Support ($70.23/hr)
Community Participation & Skill Building ($70.23/hr)
Telehealth & Virtual Delivery Confirmation
*
I confirm that the participant has a reliable device and internet connection for 100% online virtual sessions.
I understand that KINETIX operates entirely online and does not offer physical face-to-face home visits.
Submit Registration
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