NDIS Eligibility

Please fill out the appropriate boxes to arrange an appointment with our Occupational Therapy Team through NDIS funding.

Participant First Name

Participant Last Name

Phone Number

Email Address

NDIS Number

Address

Date of Birth

Referrer Details

Support Coordinator

Building Works Project Manager

Is this referral urgent?

NDIS Funding

Plan Manager Details

Has your home modification been approved by NDIS?

If known, Dates require Portable Ensuite for:

Length of time require portable ensuite for:

Medical conditions/NDIS approved disability

Is there any additional information we should know?