Make a Referral

Submit a referral for yourself or someone you support. We'll respond within 1 business day to begin the support coordination journey.

Secure & Confidential

1 Day Response

NDIS Compliant

Referral Form

Please complete all sections to help us provide the best support possible

Participant Information

Information about the person who will receive support

Full Name *

Date of Birth *

Phone Number

Email Address

NDIS Number

Address *

Participant Representative

If someone is acting on behalf of the participant (optional)

This referral includes a participant representative

NDIS Plan Details

Information about the participant's current NDIS plan

Plan Type *

Plan-managedSelf-managedNDIA-managedOther (please specify in notes)

Plan Manager Name

Plan Start Date

Plan Review Date

Plan End Date

Participant Goals

Participant Preferences

Additional NDIS Plan Notes

Referral Service Details

Specific information about the service being referred to

Referral Service *

Referral Service Contact Information

Reason(s) for Referral *

Evidence Documentation

Additional Referral Notes

Referrer Information

Your details (person making the referral)

Referrer Full Name *

Agency/Organisation *

Role *

Department

Phone Number *

Your Email Address *

Support Requirements

Tell us about the support needs and goals

Type of Support Needed

Level 1 - Support Connection

Level 2 - Coordination of Supports

Psychosocial Recovery Coaching

Not sure - need assessment

Urgency Level

Routine (7-14 days)

Standard referral processing

Priority (2-3 days)

Urgent support needs

Crisis (Same day)

Immediate risk or safety concerns

Current Situation *

Specific Support Needs *

Goals and Aspirations

Supporting Documents (Optional)

Upload NDIS plan, reports, or other relevant documents

Drag and drop files here, or click to select

Maximum file size: 10MB. Supported formats: PDF, DOC, DOCX, JPG, PNG

Consent & Privacy

Required agreements before we can process your referral

Name of Person Providing Consent *

Role/Relationship to Participant

Consent for Referral: I provide consent for this referral to be made to Support Solutions Group.

Information Sharing Consent: I provide consent for relevant clinical and medical information to be shared with Support Solutions Group and other parties representing the referral services outlined above.

Privacy Policy Agreement: I have read and agree to the Privacy Policy. I understand how my information will be collected, used, and stored in accordance with privacy legislation.

Important: By submitting this form, you are providing a digital signature equivalent to a written signature. This referral will be processed based on the consent provided above.

After submission, we'll contact you within 1 business day to discuss next steps and arrange an initial consultation.

Empowering NDIS participants across Townsville and surrounding areas to achieve their goals through professional support coordination.

NDIS Registered Provider

#4050104467

ABN: 77 647 023 694

Quick Links

About Us
Our Services
How We Work
Client Reviews
Resources
Service Agreement
Complaints & Feedback

Our Services

Level 1: Support Connection
Level 2: Coordination of Supports
Psychosocial Recovery Coaching

Make a Referral

Get in Touch

1 Jones Street

Townsville QLD 4810

(07) 4453 2220

edward@supportsolutionsgroup.com.au

Serving participants across Townsville and surrounding suburbs