Customer Support

Referral

ConnectAbility Australia values the support of individuals, business, and corporate partners. Please contact us if you could make a difference in the lives of local people.

ConnectAbility pays our respect to all Aboriginal and Torres Strait Islander peoples, their history, knowledge and continuing connection to the community and to Elders of past, present and future generations. We celebrate diversity and welcome all people regardless of ethnicity, faith, orientation or gender identity.

We create welcoming and inclusive environments for all.

Be a customer

Details of Person Requiring Support

For any additional information or assistance with completing the form, contact ConnectAbility’s NDIS team on (02) 4962 1000 or (02) 4349 3700

Name*

Identifies as*

Email Address*

Support Coordination*

Phone Number*

Community Supports*

Location*

Supported Independent Living*

Where did you hear about ConnectAbility?*

Copy of NDIS Plan Provided*

What are you requiring support with?

Additional areas of support

What areas of support are you requiring?

D.O.B*

NDIS No*

Your Message*

Caller / Referrer Details

Referrer Email

Phone Number*

Relation to potential customer:*

Details of the Person Completing this Form

Position*

What happens after we receive your information?

Once this referral is allocated to our ConnectAbility NDIS team, we will make contact to further discuss support requirements and obtain as much information as possible. If you choose ConnectAbility as your service provider we will work with you and your family/decision maker to ensure the agreement meets your current needs within the funding allocated in your NDIS Plan.

To confirm these support/service arrangements, ConnectAbility will develop an NDIS Service Agreement which will need to be approved and signed before ConnectAbility commence any supports/services.

CONFIDENTIALITY NOTE: The information transmitted, including attachments, is intended only for the person(s) or entity to which it is addressed and may contain confidential and/or privileged material.

Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and destroy any copies of this information.

Customer Support

Referral

Be a customer

Details of Person Requiring Support

What happens after we receive your information?

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