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Our Services
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Referrals
Contact Us
Our Services
About Us
Resources & Learning
Referrals
Contact Us
Make a Referral
Refer to Diverse Universe Care Support
We believe that accessing the right help should be straightforward and stress-free. If you or someone you know is in need of our support services, we are here to make the referral process as seamless as possible.
Referral
Application Form
Participant Full Name
Participant's Date of Birth
Does the Participant identify as
Not Applicable
Aboriginal
Torres Strait Islander
Participant's Gender
Male
Female
Gender Fluid
Other
Participant Disability/ies
Participant's Address
Suburb
Postcode
State
Participant's Contact Number
Participant's Email
Does the participant or representative require an interpreter?
Yes
No
Emergency Contact Name
Emergency Contact Number
Emergency Contact Email
Referred By
My self
Family Member
Friend
Support Coordinator
Local Area Coordinator (LAC)
Other
Referrer's Full Name
Referrer Contact Number
Referrer Email
NDIS/TAC Number
NDIS/TAC Start Date
NDIS/TAC End Date
Payments are Managed By
NDIA
Plan Manager
Self Managed
TAC
Worksafe
Insurance
Other
Payment Manager Email
(Please ensure the correct category of NDIS funding exists in your NDIS plan for the service being requested.)
Please select one or more required services
Supported Independent Living (SIL)
Specialist Disability Accommodation (SDA)
Short-Term Accommodation (STA) / Respite
Medium-Term Accommodation (MTA)
Personal Care and Daily Living Support
In-Home Support
Household Tasks and Cleaning
Support Coordination
Specialist Support Coordination
Community Access and Participation
Social Activities and Community Engagement
Group Activities and Centre-Based Programs
Transport and Travel Assistance
Assistance with Life Skills and Independence
Therapeutic Supports
Occupational Therapy
Psychology and Mental Health Support
Physiotherapy
Exercise Physiology
Hydrotherapy
Community Nursing Care
Accommodation and Tenancy Assistance
Sports Injury Support and Rehabilitation
Spinal Physiotherapy and Pain Management
Type of Support Required (Days & Time)
How did you heard about us?
Google Search
Ads / Promo
Social Media
TV / Newspaper
Reference
Other
Submit