Make a referral with confidence

For support coordinators, family members, healthcare professionals and community partners referring someone for NDIS support.

Participant referral form

Based on a clear, person-centred referral flow. Please confirm the participant has consented before submitting.

Website

Referrer details

Tell us who is making this referral.

First name *

Last name *

Organisation

Relationship to participant *

Email *

Phone *

Preferred contact method *

Participant details

Information about the person being referred.

First name *

Last name *

Preferred name

Date of birth

Gender

NDIS participant number

Participant email

Participant phone

Residential address

Suburb *

State

Postcode

Plan management

Requested supports

Select all services that may be relevant.

Supports required *

Assistance with Daily Life Social & Community Participation Community Transport Development of Life Skills Supported Independent Living Support Coordination In-home Nursing Group Activities

Support worker preferences

Requested start date

Additional information

Consent

Please confirm consent and authority before sending.

The participant or their authorised representative has consented to this referral. * I consent to Optimistic Disability Services collecting and using this information to assess and respond to the referral. *

This referral is stored securely and reviewed by authorised intake staff.

Other forms

Choose the pathway that best suits the enquiry.

Participant referralParticipant intake Caregiver application

Need a quick response?

Call our intake team if the participant’s needs are urgent or you need help completing this form.

1300 004 999 info@optimisticds.com.au