Service Request Form

Program Request

  • About you

  • Age 13 and over. Parent/guidance/carer is required for under 18.
  • Please select if you have any physical, sensory, psychiatric, neurological, cognitive and intellectual disability
  • Ross is deaf and uses Auslan to communicate with clients. He can be very clear and will pace his signing for people who are hard of hearing or learning Auslan.
  • Auslan interpreting supports can be arranged for parents / guidance / carer or support worker who cannot sign Auslan. This will be necessary for the introduction and program assessment sessions.
  • Will you need culture support in your program? ie. An Aboriginal or cultural worker, language interpreting support etc. so everyone understands the discussions.
  • Example: can you read and understand food information, recipes and cooking instructions?
  • It is important for Ross to be aware of any safety concerns you may have in the kitchen
  • Select Yes if you need them to help/guide/do tasks for you in the program
  • You may have a dog that bites, your house is being renovated, children at home, sick people, or anything that may be a risk for the provider coming to your house. If so, please select yes.
  • Your NDIS plan

  • If you need just a quote, go to:
  • Choose the one that is in your plan or explain in 'Other'.
  • Do you have these supports in your NDIS plan? Please select the ones you have.
  • Your Program

  • Is the program only for you or for a group of people?
  • They will depend on your location, type of program and the delivery.
  • It is important that we have a good connection for interaction and program delivery online
  • What types of video calling software do you prefer to use? FaceTime, Skype, Zoom, Duo, IMO or other
    Video call type?Your ID name or number? 
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