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 is a referral form only and does not guarantee a booking. Cairns Psychology Group charges at the standard rate as per the current NDIS pricing agreement. Please go to NDIS Pricing Arrangements 2023-2024 for more information on pricing arrangements 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
