Referral

I am completing this form as a:

Individual (Self-Referral) Family Member or Carer NDIS Participant Support Coordinator or Professional Other

Referrer Full Name

Referrer Email Address

Organisation / Agency Name

Referrer Phone Number

Full Name of Person Seeking Support

Date of Birth

Phone Number

Email Address

Current Address / Suburb

Preferred Contact Method

Phone Email Contact Representative

Primary Language & Cultural/Access Considerations

Services You Are Interested In

Social Work & Therapeutic Services Children, Young People & Families Mental Health & Wellbeing NDIS Support Coordination Disability & NDIS Therapeutic Supports Advocacy & Case Management

How is this support being accessed?

NDIS Funding (Plan Managed) NDIS Funding (Self Managed) NDIS Funding (NDIA Managed) Fee-for-Service / Direct Access (Outside NDIS) Other Funding Pathway

Background Information & Support Goals:

Strengthening Hands Services is committed to protecting your privacy and handling your personal information ethically, securely, and in accordance with relevant privacy principles. The information collected in this form is used solely to evaluate service suitability, communicate with designated contacts, and design tailored support pathways for the individual or family. We will not share your information with external agencies or third parties without explicit consent, unless required by law or in circumstances involving immediate safety concerns.

I confirm that I have obtained consent from the individual (or their legal representative) to share these details, and I agree to the collection and handling of this information by Strengthening Hands Services.

Make a Referral

Referral Form

Who We Support

We deliver professional social work intervention to individuals experiencing: