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Participant's Details

Participant's Full Name
Is the participant of Aboriginal and/or Torres Strait Islander origin?
How does the participant communicate?
Is an interpreter required?
Address

Contact Details

Service Details

Risk Assessment

Participant risks (can choose multiple)
Participant behaviour(s) of concern (can choose multiple)
Please acknowledge that you believe the information entered regarding participant risks is, to the best of your awareness, truthful and accurate.

NDIS Plan

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Click or drag files to this area to upload. You can upload up to 3 files.

Plan Management

Service Agreement

Appointment Information

Appointment location preference
Where will appointments take place? Select all if applicable (please note, travel costs will apply in all circumstances, excluding centre-based appointments). Our therapists will provide recommendations on the best location to provide therapy supports to the participant based on their goals/support needs.
Days available
Select all if applicable. Our therapists provide supports from Monday to Friday.
Preferred times available
We provide therapy supports between the hours of 8:30am to 5:00pm. Please note, that we may have limited afternoon appointment slots (particularly for school-aged children); therefore, a therapist may request alternative availabilities from you when the participant is allocated.

Acknowledgement

Please review the following consent acknowledgements and tick all boxes to confirm you understand.
Minimum Time Acknowledgement
Plan Funding
Privacy Policy
Upon submitting the form, your personal details will be sent securely to Cameron Wellness Centre. Please review and accept the privacy policy of Due Care Services and click I reviewed and I accept.