Please complete the referral form below and a JHS consultant will contact you to discuss your needs further and how you can start receiving supports as soon as possible. If you have any questions just give us a call on 1300 000 164 and one of our friendly staff will be happy to help.

    PERSONAL DETAILS
    DATE OF BIRTH
    TYPE OF SUPPORT REQUESTED
    Disability Support WorkerSupport Co-ordinationBehaviour Support (Improved Relationships)Behaviour Support (Improved Daily Living)
    GETTING THE SERVICE AGREEMENT SIGNED
    Who will sign the Service Agreement?
    ClientRepresentativeNo signature required
    If representative signing - name and relationship of the person to the client
    Phone & e-mail of person signing the Service Agreement
    Can the Service Agreement be sent through Docusign?
    YesNo
    If No please indicate how you would like the Service Agreement to be delivered:
    The NDIS plan including identifying information, details of the supports to be provided (type, quantity, funds allocated) and the participants goals