Refer a Participant

We value your feedback.

Partner with us: Our Referral Process

Holistic Horizons is committed to providing high-quality care for NDIS participants and Older Australians. We value our partnerships with families, advocates, and coordinators, and we have made our referral process as straightforward as possible.

Our 3-Step Process:

  • The Referral: Complete our streamlined online form to provide the essential details.
  • The Connection: We contact the participant directly to arrange a comprehensive intake session.
  • The Outcome: We identify their specific requirements and goals to ensure a smooth transition into our services.

    We'd love to help by complete our streamlined online form
    to provide the essential details
Why Choose Us Why Choose Us

NDIS Plan Managers Details

First Name
Last Name
Email
Phone
Agency/Organisation

Support Coordinator/LAC details (if this contact is the not the referrer)

First Name
Last Name
Email Address
Phone
Agency/Organisation

Referrer Details (if not Support Coordinator)

First Name
Last Name
Email Address
Phone
Company

NDIS Participant Details

NDIS Participants First Name
NDIS Participant Last Name
Phone
Email Address
Date of Birth
Male / Female / Other
Street Address (include City/State and Postcode)
NDIS Participant Number
Plan Type - Plan Managed / Agency Managed - Self Managed
Plan Start Date
Plan End Date
Service Requested (Respite/MTA/SIL/Community Access/In-Home Support/Group Activities /other)

Reason for Referral

What is the primary and secondary disability
Is an interpreter requiried (Yes/No)

Behaviour Support Plan

Is there a PBSP in place?
Any restrictive practices in place?

Decision Maker Contact Details (Parents/guardian/nominee)

Decision Maker First Name
Decision Maker Last Name
Decision Maker Phone Number
Decision Maker Email
Role / Relationship to NDIS Participant
Additional Notes (funding ratios - Hours/Days and time of day support requiried or behaviour of concern eg: lashing out)