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Request a service.

Referrals are welcomed from individuals, family members and health professionals.
A mother and father sitting outside watching their baby play.

Request a service

Take the first step towards greater independence

We're ready and waiting to support your personal goals. Let's get started by completing this form.


Referrer Details



If you feel you’re not represented in the fields above please give us a call on 1800 804 805 and we’ll revise our fields to better represent you.






For landlines please add area code, please ensure that there are no spaces between the numbers.


Client/Student Details:




If you feel you’re not represented in the fields above please give us a call on 1800 804 805 and we’ll revise our fields to better represent you.

Please enter Date of Birth in DD/MM/YYYY Format Ex: 25/12/1980 for 25th of December 1980.

If you feel you’re not represented in the fields above please give us a call on 1800 804 805 and we’ll revise our fields to better represent you.




For Landline please include area code, please ensure that there are no spaces between the numbers.

Address: 








DEX Information
The Department of Social Services Data Exchange enables information sharing between funding agencies and service providers, which helps to improve service delivery and understanding the overall outcomes being achieved for individuals, families and their communities.











E.g. Medical Documents, Vision Condition Information
Additional Details










Please provide details of their vision status:

Please enter Date in DD/MM/YYYY Format











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Contact Information

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