NDIS Funded

If your child is part of the NDIS program and you’re looking for personalized support, we’re here to help. Kindly complete the form below with your details, and one of our friendly team members will get back to you promptly. Together, we can explore the best options to support your child’s needs and wellbeing.

Full Name*

Have you obtained a Mental Health Care Plan (MHCP) in the last 12 months*

Date of Birth*

Home Address*

Parent/Guardian/self (Note: only one guardian is required)*

Contact Number*

Email Address*

School ( if applicable)*

Is there any Court Order in place? If yes, we will request a copy of the relevant Documents*

.NDIS Plan Number*

NDIS Start Date*

NDIS End Date

What Best describes the reason for the referral

Psychological Support

Psychological Assessments

OT Therapy

OT Assessments

OT Mental Health Therapist

Speech Pathologis

Dog Therapy

Artistic/ Creative Therapy

Psychosocial Therapy

Therapy Assistant

Mentoring

Group Therapy Programs

I would like the Grow Wellbeing therapy coordinator to complete a Holistic Assessment with me

What would you/your client like to achieve from this referral?*

Have you/your client received Therapeutic Support within the last 6 months?*

If your answer to question 15 is yes please describe (Optional)

Do you/your client have a behavioural support plan in place?

Are you/your client interested in home visits during School Holidays or after school?*

Are you/your client interested in participating in group sessions?

Please provide any other information you would like to share with us

121 North East Road, Collinswood SA 5081

Tel: 08 8234 2562

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