Referral

Make a Referral

Refer a Participant

To refer a participant to Assist Care Cairns, please complete our secure online referral form. All information is handled in accordance with our Privacy Policy. Our team will review the referral and contact the most appropriate person to discuss next steps.

Takes about 8–10 minutes Submitted securely No clinical documents required

What happens next

A clear and considered referral process.

01
Complete the referral
Tell us about the participant, their plan and requested support.
02
Our team reviews it
We check the information and whether the support matches our scope.
03
We discuss next steps
The most appropriate person will be contacted for a conversation.

Who can make a referral?

NDIS Participant
Family Member
Nominee
Guardian
Support Coordinator
Plan Manager
Allied Health Professional
Hospital or Community-Service Team

Protect sensitive information

Do not upload or send medical records, clinical reports or highly sensitive documents through this form. Our team will arrange an approved secure process if documents are needed after initial contact.

Before you begin

Please make sure you are authorised to provide the participant’s information and that the participant or representative understands they may be contacted.

Secure referral form

Participant Referral

Fields marked with an asterisk are required. Provide only information relevant to arranging an initial support discussion.

Participant InformationWho the referral is for and how to reach them

Participant Full Name

Preferred Name (optional)

Date of Birth

Phone (optional)

Email (optional)

Address or Suburb (optional)

Preferred Contact Method

Communication Requirements (optional)

NDIS InformationPlan details relevant to the requested support

NDIS Participant Number

Plan Management Type

Plan Start Date (optional)

Plan End Date (optional)

Relevant Funded Support Category (optional)

Referral InformationThe support being requested and any context our team should know

Requested Service

Preferred Days and Times (optional)

Required Commencement Date (optional)

Participant Goals

Current Support Needs

Mobility or Accessibility Requirements (optional)

Behavioural or Safety Considerations (optional)

Provide only information needed for safe initial contact. Do not attach clinical reports.

Other Providers Involved (optional)

Referrer InformationYour details, so our team can follow up on this referral

Referrer Name

Organisation (optional)

Relationship to Participant

Phone

Ready to Start Your Support Journey?

Refer a Participant

A clear and considered referral process.

Participant Referral

Let’s discuss your goals and next steps.