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PARTICIPANT INFORMATION
Tell us about yourself
I am a (please select what is appropriate):
NDIS Participant
Parent
Support Person
LAC/Support Coordinator
Plan Manager
Other, please specify:
If you are not the participant, please tell us:
Tell us about the participant:
Participant's gender
Male
Female
Other
Participant's address and contact details:
What services are required:
Supported Individualised Living (SIL)
Individualised Living Options (ILO)
Specialist Disability Accommodation (SDA)
Medium Term Accommodation (MTA)
Short Term Accommodation (STA)
Social and Community Participation
Assistance with daily living
Support Coordination
Individual and group activities
Behaviour support
Other
How would you prefer to receive these services?
Face-to-face
Telehealth
Either/both
Do you have an approved NDIS plan or are you awaiting approval?
I am awaiting approval
I have an approved plan
How will funds be claimed?
Agency Managed
Plan Managed
Self-Managed
Tell us more about the participant:
Is there a Guardian involved?
Yes
No
Is there a Support Coordinator involved?
Yes
No
Will an interpreter be needed?
Yes
No
How did you hear about us?
Google
Facebook
Instagram
Word of Mouth
Other
