NDIS Referrals - Care Squared Kids

Your Details

What is your relationship to the child?

Your Name*

Your Phone*

Your Email*

An email notification confirming the successful submission of your referral will be sent to this address.

Child's Details

Child's Name*

Child's Date of Birth*

NDIS Number*

Participants first language*

Primary Carer

Name*

Relationship to Child*

Phone Number*

Email*

If there are specific guardianship arrangements or Child Safety involvement, please provide all names, relationships, contact numbers and emails required to ensure we are able to keep all relevant parties informed, gain authority to share information accurately and ensure we adhere to safety policies.

Care Squared provides therapy services to support children and families to work on the goals they feel are important and to achieve those key outcomes:

What is the key area that you would like input from Care Squared for at this time?

Allied Health services that are funded by NDIS must address the stated goals in your NDIS plan.

Please attach or list your child’s NDIS goals and list which goal is most important to you now (this may change over time, but it helps us focus on what is most important to you at the moment and ensure this is addressed, within the funding allocated).

Attach Here

Max. file size: 1 GB.

The most important goal to us right now is:

Name of Kindergarten / School / Childcare Centre:

Contact person, role and contact number:

Service Location

Support Name (1)*

Support Service Provided (1)*

Support Phone (1)

Support Email (1)

Support Name (2)

Support Service Provided (2)

Support Phone (2)

Support Email (2)

Support Name (3)

Support Service Provided (3)

Support Phone (3)

Support Email (3)

NDIS funds some interpreter services. To provide your service will you require an interpreter? If so what type?

More Information (if you would like to provide more details to help us to ensure we provide services to match your needs/preferences)

What happens next?

Thank you for filling in our Care Squared Kids referral form. We are looking forward to supporting you.

You should receive an email confirming the successful receipt of your referral. Please contact us if you do not receive this within the next 30 minutes. Please remember to check your spam/junk folders too.

Once your form has been received, one of our lovely Customer Carers will review your needs and get in touch to let you know how our team of NDIS accredited and approved allied health professionals can best support you.

We know that they NDIS system can sometimes be overwhelming, so if you need to speak to us before then please call us on 1300 632 639 or fill out our Contact Form on this website and we will get in touch.

Name

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