Get SupportReach out to our team and we’ll guide you through the next steps Referral Form Referrer Details First Name Last Name Phone Email Relationship To Participant Participant Name * First Name Last Name Date of Birth * Gender * Male Female Intersex Non-binary Unspecified Prefer not to say Aboriginal or Torres Straight Islander? Yes No Address * Phone Email NDIS # * NDIS Plan Dates Emergency Contact Name and Contact Details Preferred Contact Person Invoicing Arrangements * Agency Managed, Plan Manager or Self Manager Email Address Disability and Mental Health Information * Diagnosis, Medication, Mobility, Other Health Information Type Of Support Requested * Community Participation, Personal Care, Counselling, Behaviour Support. Support Worker Preference Age, gender, hobbies, etc. Preferred Days and Total Hours of Support Requested * Spefic Days/Times if Known Goals * Risks * Outline Any Risks to Self, Staff, or Others Strategies In Place to Manage Risks * E.g. 2:1 Support, Restrictive Practices, Triggers to Avoid, Best Ways to Work With/Communicate With Client Will support workers require specific training to adequately understand and meet the participant's needs? * If yes, what training is required: (E.g. mental health first aid, manual handling, medication management, etc) Other Important Information We Should Know About How Did You Hear About Support Studio? * Thank you!A member of the Support Studio team will be in touch shortly. Be a part of our community Sign up with your email address to receive news and updates. First Name Last Name Email Address Sign Up Thanks so much! We’ve got your info and have added you to the list.
