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Make a referral
Participants can refer themselves. A referral can also be made by a family member, professional or service provider with the participant’s consent, or consent from their authorised nominee or guardian.
Not sure what you need? Answer six quick questions first . Fields marked * are required.
Who can make a referral?
NDIS participants Parents, carers and family members Nominees, guardians and advocates Support coordinators and recovery coaches Plan managers Support workers and disability service providers Schools and early learning services GPs, paediatricians and allied health professionals Hospitals, community services and government agencies
If someone is in immediate danger, call 000. This form is not monitored around the clock.
Prefer to talk now? Call us on 1800 246 808 .
Call or email me Leave your details and we’ll get back to you. Takes 30 seconds.
Make a full referral Tell us a bit more so we can get started sooner. Takes about 2 minutes.
Leave this empty
About you
Your name *
Relationship to the person *
Choose one I am the participant Parent or carer Family member Nominee, guardian or advocate Support coordinator or recovery coach Plan manager Support worker or disability provider School or early learning service GP, paediatrician or allied health Hospital, community service or government agency Other
Phone *
Email
About the person needing support
Their name *
Town or community * Broome Derby Fitzroy Crossing Kununurra Karratha Port Hedland South Hedland Carnarvon Onslow Exmouth
NDIS plan management Not sure Self-managed Plan-managed NDIA-managed Not an NDIS participant yet
What is happening, and what support are you looking for? * A few sentences is plenty. We’ll ask about the rest when we call.
Any urgent safety concerns?
Consent
I confirm that the participant, authorised nominee or guardian has consented to this referral and to the sharing of the information provided. *
Send referral