Make a Referral

Connecting People to the Support They Deserve.

Submit a referral quickly and securely using the form below. Whether you’re a support coordinator, GP, or family member — we’re here to help.

How to Refer Someone

At Embrace Care, we believe accessing the right support should be easy. Use the form below to refer a participant to our services — whether you’re a healthcare provider, support coordinator, or someone close to the individual. Once submitted, our team will follow up promptly to guide the next steps.

PDF version available below.

Participant Details

First Name

Last Name

Date of Birth

Country of Birth

Aboriginal or Torres Strait Islander?

Land Line

Mobile Number

Participant Email Address

Residential Address

Key Contact for Appointments

Emergency Contact Number

General Referral Notes

NDIS Plan Details

Does the participant have an NDIS plan?

NDIS Number

NDIS Plan Dates

Self-Manage

The participant has chosen to self-manage the funding for NDIS supports provided under this service agreement. After providing those supports, SWCS will send the participant an invoice for those supports for the participant to pay. The participant will pay the invoice by direct debit / cash / cheque / EFT within 7 days.

Participant Nominee

The participant’s Nominee manages the funding for supports provided under this Service Agreement. After providing those supports, SWCS will send the participant’s Nominee an invoice for those supports for the participant’s Nominee to pay. The participant’s Nominee will pay the invoice by direct debit / cash / cheque / EFT within 7 days.

NDIA-Managed

The participant has nominated the NDIA to manage the funding for supports provided under this Service Agreement. After providing those supports, SWCS will claim payment for those supports from the NDIA.

Plan-Management Provider

The participant has nominated the Plan Management Provider to manage the funding for NDIS supports provided under this Service Agreement. After providing those supports, SWCS will claim payment for those supports from the participants nominated Plan Management Provider.

Contact details of Plan Manager Provider or individual responsible for payments if self-managed

Name

Contact Number

Plan Manager Provider Email Address

Address

NDIS Plan Details

NDIS Plan Overview (if available)

NDIS Funding Details (if available)

Guardian / Plan Nominee Details (If Applicable)

First Name

Last Name

Land Line

Mobile Number

Guardian Email Address

Residential Address

Relationship to participant

Referrer Details

First Name

Last Name

Role (If Applicable)

Land Line

Mobile Number

Referrer Email Address

Organisation

Referral Reason

Participant Summary

Disability Summary (Please detail below)

Medical Condition / Diagnosis (Please detail below)

Vision

Hearing

Speech

Non-Verbal

Mobility / Transfers / Mobility Aids

Cognition

If answered “YES” on any of the above, please provide further detail:

Does the participant require an interpreter?

If answered “YES”, please provide further detail

Does the participant have any behaviour of concern?

If answered “YES”, please provide further detail

Does the participant have a behaviour support plan?

If answered “YES”, please provide further detail

Safety concerns in the participant’s residence?

If answered “YES”, please provide further detail

Worker preference (Gender, culture, level of skill, etc.)

Accommodation / tenancy

Assistance in personal activities

Assistance in travel / transport

Daily tasks / shared living

Innovative community participation

Development of life skills

Household tasks

Participate community

Group / center activities

If answered “YES” on any of the above, please provide further detail

Consent

I consent to my information being provided to Embrace Care for the purposes of referral, service delivery and inclusion in de-identified data reporting.

Make a Referral

Connecting People to the Support They Deserve.

How to Refer Someone

PDF version available below.

Participant Details

NDIS Plan Details

Contact details of Plan Manager Provider or individual responsible for payments if self-managed

NDIS Plan Details

Guardian / Plan Nominee Details (If Applicable)

Referrer Details

Participant Summary

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