NDIS Client Referral

Referral Guidelines

  • To refer a client, please complete this form and return it; along with any detailed correspondence that you feel we will require to assist with the referral process.
  • The referral needs to be discussed with the client or their guardian and they should agree to the referral.
  • The referral can be completed by a Service Organization or can be a self-referral with the response being completed within 2 business working days.
  • Once the referral is accepted, you will be notified to discuss commencement date. Support is provided once or twice a week with the case management plan reviewed monthly. The standard client support period is for three months and can be extended if required.
  • Only one referral can be given per client. If a client is referred by more than one Service Organization, the first referral received will be the one assessed.

**Note: Please upload any supporting documents with the referral (e.g., your NDIS plan). A response will be made within 3-5 business days.

PARTICIPANTS DETAILS

Participant's Full Name:
NDIS Plan Start Date:
NDIS Plan End Date:
Date of Birth:
Sex:
Address:
Is the participant currently working?

MODE OF COMMUNICATION

Communication Preference
Interpreter Required
Does the participant have an advocate?
Advocate Full Name:
Address:

REFERRAL DETAILS

Date of referral:
Name of Referrer (Your Name):
NDIS Support Area
Payment method
Address:

Where to find us

African Family Services

Level 2, 134 Cambridge St, Collingwood, VIC 3066.
We acknowledge that our office is on the lands of the Boonwurrung and Wurundjeri Traditional Owners of the Kulin nation.

Connect With us via

Contact us

We are here for you. Send us an email through the contact form below and we will respond within 3 business working days.