Referral | Equalplus

Intake & Referrals

At Equalplus, we simplify the intake and referral process to provide a smooth and supportive experience for our participants. Our professional team will assist you at every stage, from the initial inquiry to the implementation of tailored support services. Simply reach out to us, and we will guide you through each step.

During the intake process, we take the time to understand your unique needs, goals, and aspirations. Our experienced coordinators collaborate with you and your family to develop a personalized plan that meets your specific needs. We also accept referrals from community organizations and healthcare professionals, as well as self-referrals.

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Participant Details

First Name

Last Name

Date of Birth

Gender

Home Address

Participant Phone Number

Participant Email Address

Participant NDIS Number

Does The Participant Have A Legal Guardian / Nominee?

YesNo

Cultural Details

Participant Country Of Birth

Does The Participant Require An Interpreter?

Relevant Culture Or Religious Considerations(If Any)?

Does The Listed Participant Identify As An Aboriginal Or Torres Strait Islander?

Services Request

Type Of Primary Service Required:

Number Of Hours Requested For Service:

Type Of Secondary Service Required:

Additional Service Required:

Participant's Relevant Conditions / Disability (Please List):

Extra Information That May Assist With Preparation For Initial Appointment:

Special Assessments Or Therapies Required:

Notes For Practitioners (Additional Relevant Details):

Booking Details

Preferred Consultation Type(s):

In ClinicIn Home ServiceTelehealthCommunity

Who Should We Contact To Make An Appointment?

Notes For Reception Staff (If Applicable):

NDIS Information

Participant’s NDIS Plan Type