Please complete this form if you are self-referring or are referring on behalf of an NDIS Participant.

Please complete this form if the Claimant has a WorkCover or Motor Vehicle Accident claim

Please complete this form if you are referring a client who is not NDIS funded.

If you are an NDIS Participant, you will need to complete this Service Agreement prior to scheduling your initial appointment with us.

Prior to completing this form, it will be helpful to have a copy of the front and back of your Driver’s Licence and a TMR Medical Certificate (if you have an ‘M’ condition on your Driver’s Licence or if you have a medically suspended Driver’s Licence) to upload to this form.

This form is to be completed by the Claimant’s Case Manager in conjunction and with the consent of the Claimant.

Driver’s Licence details are required along with a TMR Medical Certificate if one has been issued at the time of the referral.