Refer to

Capability Support Services

Looking to refer someone to Capability Support Services? You’re in the right place. We provide NDIS-approved services tailored to individual needs. Fill out the form below, and our team will contact you to discuss how we can best support your referrals.

Referrer Details

Are you submitting this referral for yourself?

No, this referral for is for someone else Yes, this referral form is for me

Do you have consent from the person that you are referring or their representative to share the information in this form?

Yes No

Referrer Name

Referrer Email

Referrer Phone

What services are you interested in?

What is required?

Assessment report Only Ongoing Therapy Ongoing Therapy & Report Telehealth

Participant Details

Participant name

Participant address

Participant Date of Birth

Participant Gender

Male Female Other

Is there a Guardian? If yes, please enter details.

Plan Nominee name

Plan Nominee email address

Plan Nominee phone number:

Other Details

Reason for Referral

Primary Disability & Support Needs

NDIS Goals

Is the participant on the new PACE system with the NDIS?

Yes No Unsure

NDIS Participant Number

NDIS Plan Start Date

NDIS Plan End Date

Plan Management Company Details (if applicable)

Budget /Hours allocated for each chosen service to assist us with creating a Service Agreement

Please provide any other useful information that will assist us with creating a Service Agreement

Please outline any urgent specifications/deadlines for assessments/reports.

Preferred Delivery of Services

At Home In the Community At School Other

Provider (SIL/SDA) Name/Contact Details (if applicable)

Upload NDIS Plan details (relevant sections only)

Upload any collateral documents/past reports

Note: To upload multiple documents, please select all documents at once when uploading.

Consent

I agree with the Privacy Policy prior to submitting this form.

How did you find us?

Safety- are there any Risks we should be aware of?

Safety- Other Risks we need to know about

Welcome to Capability Support Services, your trusted registered NDIS provider dedicated to enriching lives and fostering independence.

1800 299 399

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Who We Are

Reg No: 4-JFXPAFQ

NDIS

Services

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Acknowledgement to the Country

Capability Support Services acknowledges the Traditional Custodians of the land on which we work and live. We honour their connection to land, waters, and community. We pay our respects to Elders past, present, and emerging, and extend that respect to all First Nations people today.