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