Initial Referral Form

There is a range of information that we need from you in order to commence, so we provide you with two options:

There is a range of information that we need from you in order to commence, so we provide you with two options: Complete a referral form, where you provide us with all the information needed to get you set-up and ready to go

Complete a initial referral form, where you provide us with just some of the necessary information. Then, once we receive your form, we will contact you via telephone to get the additional information.

At any stage our team are ready and willing to help you. Simply call us on Ph: 1300 192 611or email us at [email protected]

Your Details

Participant details

First Name

Last Name

Phone Number

Email Address

Participant details

Your NDIS number

Your date of birth

NDIS Plan start date

NDIS plan end date

Gender

Address

Suburb

State

Postcode

Support Person

Frist Name

Last Name

Phone Number

Email Address

LAC/Support Coordinator

First Name

Last Name

Phone Number

Email Address

Company Name

Your position title

Disability background

Disability History

It would be very useful in identifying goals and funding type if you could share your NDIS plan with us (or relevant pages from that plan). Please upload it here

Medical Information: If you are able to, please provide any copies of relevant health and medical documentation including allied health and other medical reports, that will assist us to commence services with you. If the files are too big, please email them directly to our concierge at [email protected] after submitting this online referral form.

Services required

AAAR Ability Assist bills the Services according to the NDIS price guide and will only use the required amount of funds to service your service request. If you are not sure our skilled team member can assist you.

Consent and payments

I understand the estimated cost for the service requested on behalf of the participant. I consent to AAAR Ability Assist commencing services up to the limit provided. If there is any change to this estimated cost, AAAR Ability Assist will provide a written Service Funding Approval document for review and approval from relevant parties. Please contact our Concierge Team if you require additional information regarding costs of services

Who will manage payments?

Comment:

Any additional information or comments?

Phone

1300 192 611

Phone

1300 192 611

Make a referral

Phone

Phone

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