← All referral forms NDIS Referral

NDIS referral form

iHelp is an NDIS support provider and can accept self-managed, plan-managed and agency-managed participants. Please complete the form below with as much detail as possible so our team can understand the participant's needs. If you're unsure about any sections, you can leave them blank and we will follow up.

Participant details

Tell us about the person being referred for support.

First name *

Last name *

Preferred name (optional)

Sex

Date of birth

Phone *

Address line 1

Suburb / Town

State

Postcode

How should we organise the first visit?

Contact the participant directly No, contact another person (provide details below)

Support needs

Help us understand the participant's disability and the support they're looking for.

Diagnosis / disability (as listed with NDIS)

Reason for referral / supports requested

Daily Personal Activities Community Participation Household Tasks Community Nursing Care High Intensity Support Travel & Transport

NDIS plan details

Funding information helps us set up the right service agreement.

NDIS number

How is the plan managed?

Plan start date

Plan end date

Plan manager (name & contact, if plan-managed)

Upload a copy of the NDIS plan (recommended)PDF, Word or image. Max 8MB. You can also email this to us later.

Home visit & access

Are there any potential risks for staff visiting the home?

Yes No

Referrer / coordinator details

The person completing this form. You can refer yourself, or on behalf of someone else.

Your name *

Your email *

Your phone

Provider / company (if applicable)

Upload a recent FCA / OT report (optional)

Any other relevant document (optional)