Make a Referral

For support coordinators, health professionals, family and carers. Share a few details below and our team will take care of the rest.

Participants & Carers Referrals

Fields marked * are required.

About you

Your full name *

Organisation (if applicable)

Your role *

Support CoordinatorLAC or NDIA PlannerHealth professionalFamily member or carerOther

Phone number *

Email address *

About the participant

Participant full name *

Suburb or postcode

NDIS number (if known)

How is the plan managed? *

Self managedPlan managedNDIA managedNot sure

Supports requested

Choose as many as apply. *

Support CoordinationRecovery CoachingSupported Independent Living (SIL)Assistance with Daily LifeCommunity AccessTransportOvernight SupportsMentoringShort Term AccommodationDay Options or Group ProgramsSomething else

Tell us what else is needed

Approximate hours or schedule (if known)

Anything we should know? Risks, behaviours of concern, communication needs or goals.

Consent

I confirm I have consent to share this participant’s details with Authentic Care & Support Services. *

We only use these details to respond to this enquiry. You can read our privacy information here.

Authentic Care & Support Services acknowledges the Traditional Custodians of the lands on which we live and work across South Australia, the Kaurna people of the Adelaide Plains, and pays respect to Elders past and present. We extend that respect to all Aboriginal and Torres Strait Islander people in our community.

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[email protected]
08 8486 1194

ABN 72 647 811 818

Our NDIS supports:

Support Coordination • Recovery Coaching • Supported Independent Living • Assistance with Daily Life • Community Access • Transport

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