Referrals · Victoria

Referral Form.

Complete our Referral Form online or download our original document. You can refer yourself or someone else, with their consent or lawful authority.

Complete the Referral FormDownload our form (Word)

Need help or another format? Call (03) 7042 3487.

Complete your referral online

Based on our company Referral Form. Share information relevant to the referral. Contact our team to arrange a suitable way to provide detailed medical records or attachments.

We welcome referrals for children and adults. For a child, include parent or guardian details and relevant consent below.
Optional if you prefer us to call. We use this to reply about the referral.
For a participant under 18, describe who is involved in decisions, preferred contact and any relevant consent arrangements. Do not upload identity or court documents here.
Include only people the participant wants involved, with consent or lawful authority.
Share only information needed to assess this referral. Contact our team to arrange a suitable way to provide detailed medical records or plans.
Describe prompting, assistance or administration needed and whether a current medication support plan or instructions are available. Contact us to arrange a secure way to provide detailed records.
Tell us about the assistance required, relevant health professionals and any current care or emergency plans. We discuss assessment, staff competency and planning before agreeing to specific tasks.
Tell us whether an assistance animal will be present and how it supports you. Include any other information that helps us plan access and support safely.
Contact our team before providing detailed behaviour support plans or other sensitive attachments.
These options identify referrals to other professionals; they do not mean we provide the clinical service.
Tell us about connections you would like help arranging. Allied health, clinical, education and employment services may be delivered by other providers.
Describe what the participant wants support with and any other services requested.
Tell us about school, study, work or transition goals, and any services you would like us to connect with, with your consent.
If someone is in immediate danger, call 000. This form is not an emergency service.
Read our Privacy Policy. You can ask about access, correction or changing consent. A referral does not confirm a service or start date.

Your referral and intake

  1. Initial contact and welcome information. We discuss the support requested and availability, then provide our Welcome Pack and Participant Handbook in a format you understand.
  2. Meet and greet. We meet with you and the people you choose to discuss your needs, goals and preferences, answer questions and complete relevant intake documents.
  3. Prepare your support. We finalise your service agreement, schedule of supports, consent, assessments and plans. We gather any further information, arrange referrals with your consent and introduce relevant workers. A familiarisation or trial period is discussed where appropriate.
  4. Begin and review support. We arrange rostering, worker orientation and the agreed support. We monitor how it is working with you and review your support after three months, or sooner if needed.

The timing depends on your needs and the service. If support is unavailable, we can discuss a waiting list with you and provide monthly updates. Tell us if you would like an advocate, interpreter or help with the forms.

Your rights and responsibilitiesPrivacy PolicyContact us