NDIS referral form

Refer a participant to Corewell.

Use this form to refer yourself, a family member or a participant for Corewell allied health and support services. The more detail you can provide, the easier it is for our team to respond with the right next step.

Before you start

Have participant contact details and NDIS plan information ready if available.
Share any risk, access, communication or interpreter needs early.
Confirm the participant or authorised representative consents to the referral.

Step 1

Referrer details

Tell us who is completing this referral and how we should follow up.

Referrer name *OrganisationPhone *Email *Relationship to participantPreferred contact method

Step 2

Participant details

Provide the participant's details and communication preferences.

Participant full name *Date of birthParticipant phoneParticipant emailSuburbPostcodePreferred communicationInterpreter or communication needs

Step 3

NDIS plan details

This helps us understand funding and service pathways.

NDIS numberPlan management typePlan start datePlan end dateSupport coordinator nameSupport coordinator email

Step 4

Services requested

Select the support areas that best match this referral.

Reason for referral and current goals

Step 5

Support needs and risk information

Share anything that helps us plan a safe and respectful first response.

Referral urgencyPreferred appointment type

Current supports involvedSafety, behaviour, medical or access considerations

Step 6

Consent and documents

Confirm consent and note any reports that can be shared after submission.

Consent confirmedRelevant documents available

Additional notes

Selecting submit will open your email app with the referral details. If that does not open, email the team directly at admin@corewellallied.com.au.

Need help completing the form?

You can also contact Corewell first if you are unsure which service is the right fit.

Contact Corewell