Details of the person requiring Support

Title *
Gender *
Identifies as *

Alternate Contact

Guardian/Next of Kin

Support Coordination *

Support Services *

Copy of NDIS Plan Provided

GP details of the person requiring support

Information you wish to share

We recognize the health and disability needs and supports of each participant in the NDIS. A GP is an important member of a person’s care team and we may need to communicate with the GP practice if a participant requires additional supports outside of the NDIS plan.

Details of the person completing this form

What happens next?

Please email this completed form along with the NDIS Plan to: info@ainimsupportservices.com.au. For any additional information or assistance with completing the form, contact Ainim Support Services friendly team on 0434631341.

What happens after we receive your information?

Once this referral is allocated to our team, we will make contact to develop a Service Agreement. The agreement will need to be approved and signed before any services commence. We will work with the NDIS participant and their decision maker to ensure the agreement meets their needs to organise the best supports available.

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