NDIS Referrals For all new NDIS client referrals please fill out the NDIS referral form below Please enable JavaScript in your browser to complete this form.Please note, this form is for referrals only and doesn’t guarantee a booking. Cairns Psychology Group charges the standard rates set by the current NDIS pricing agreement. For more details on pricing, please visit the NDIS Pricing Arrangements page. NDIS Participant Information NDIS Participant Name *FirstLastDate of Birth *NDIS Number *How is the NDIS Plan being managed? *Self ManagedPlan ManagedClient Preferences and RequirementsWhat type of sessions would the client prefer? *Face to FaceTelehealthPhoneCairns Psychology Group has a set of stairs to enter the office. Will the client be able to attend face to face? YesNoPreferred Clinician Type PsychologistPsychotherapistSocial WorkerNo Preference/Best SuitedPreferred Clinician Gender MaleFemaleNo PreferenceWhat is the clients diagnosis/disability? What would the client like to get out of seeing a therapist? Does the client need an assessment or report for NDIS? *YesNoIf you answered yes to the previous question, please specify what is required. What is the clients current living situation? *Living IndependentlyLiving Independently with social workersLiving with parents/guardians/caregiversSIL HouseOtherDoes the client require someone to attend appointments with them? *YesNoIf Yes, who will be attending and what is their relationship to the client? Please put any extra information below. Please upload any relevant files here. Click or drag a file to this area to upload. Support Co-Ordinator Information Name *FirstLastCompany Name Contact number *Email Address *Submit
