Refer Now | Everyday Independence

Your Details

Please enter your information below.

First Name*

Last Name*

Phone Number*

Note: Include area code for landline numbers.

Email*

Organisation Name*

Organisation State or Territory*

Relationship to person being referred*

How did you hear about Everyday Independence?*

Please add participant's external client ID/ reference ID*

Person Seeking Therapy Details

Please enter your client’s information below.

First Name*

Last Name*

Preferred Contact Number

To receive courtesy appointment reminders, please enter a mobile phone number.

Mobile

Landline

Mobile Number

Landline Number

Note: Include area code for landline numbers.

Email Address

Date of birth*

DD slash MM slash YYYY

Date format must be dd/mm/yyyy

Do they identify as Aboriginal or Torres Strait Islander?

Age

Residential Address

Street Address*

Suburb*

State or Territory*

Postcode*

Services

While we ask what type of therapy your client requires, Everyday Independence brings a range of complementary team skills to plan and deliver therapy that’s tailored to make the most of their NDIS funding.
All children younger than nine will be supported by an early childhood key worker.

Services required*

Occupational Therapy

Speech Pathology

Physiotherapy

Early Childhood Supports

Positive Behaviour

Functional Assessment

Habit Coach

We provide early childhood supports (early childhood intervention services) to all children under nine, and their families. We use a key worker model because it achieves the best outcomes for the child and family.

A family’s therapy team depends on the child’s needs and available therapists, but they can always count on having a key worker and at least one therapist, like a speech pathologist, occupational therapist, or physiotherapist.

Our early childhood supports are not available with private health or Medicare funding.

To help you better understand how we deliver early childhood supports, please take a few minutes to watch this short video

To access Positive Behaviour Support, the NDIS plan must have funding under Improved Relationships or Behaviour Support.

Do they have Improved Relationships or Behaviour Support funding on their NDIS plan?*

Habit Coaching is offered as part of our therapy package, please ensure another service is selected also.

Tell us about their goals and how we can support them:*

Do they have a practitioner preference?

Male

Female

No preference

Family or Support Contact Details

Please enter your client’s family or support contact details, if relevant.

Parent/Guardian?

Parent/Guardian

First Name*

Last Name*

Phone Number*

Note: Include area code for landline numbers.

Email*

Support Coordinator?

Support Coordinator

Use my details

First Name*

Last Name*

Phone Number*

Note: Include area code for landline numbers.

Email*

Plan Nominee?

Plan Nominee

First Name*

Last Name*

Phone Number*

Note: Include area code for landline numbers.

Email*

Who should receive communications relating to updates to appointments, service delivery and waitlists?

Please note the communication recipient must be +18 yrs of age.

Use my details

Use details of person seeking therapy

Use parent details

Use Support Coordinator details above.

Use Plan Nominee details above.

First Name*

Last Name*

Phone Number*

Note: Include area code for landline numbers.

Email*

Non-verbal

Please tick if non-verbal

Relationship to the person seeking therapy*

Funding Details

Please enter your client’s plan details.

Does the person have an NDIS Plan?*

Yes

Awaiting Plan Approval

Please call us to find out how your client can access our services, if they don’t have a NDIS Plan.

Participant NDIS number*

Funding Type*

Plan Managed – Organisation name*

Plan Managed – Email*

NDIS Plan Start Date

DD slash MM slash YYYY

Date format must be dd/mm/yyyy

NDIS Plan End Date

DD slash MM slash YYYY

Date format must be dd/mm/yyyy

NDIS Plan

Accepted file types: pdf, jpg, png, Max. file size: 5 MB.

Please attach a copy of NDIS plan here. Otherwise, you can email this through to referral@everydayind.com.au

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What to Expect

Our Therapies

Work with Us

Client Referral

Your Details

Person Seeking Therapy Details

Residential Address

Services

Family or Support Contact Details

Who should receive communications relating to updates to appointments, service delivery and waitlists?

Funding Details