Who should we contact with Provider options? Your Name * Your Surname * Telephone * Email * What best describes you? * - Select -ParticipantParent/Carer/FriendService ProviderSupport CoordinatorPlan ManagerLAC I would prefer to be contacted by AnyPhoneEmailSMS Would you like us to send Provider options to the Participant? (A copy will be sent to you) Yes No Participant Email * Participant Phone * Contact Notes for Participant Location of the person needing the service Your Suburb * Your Postcode * Your State * - Select -ACTNSWNTQLDSATASVICWA Details of the person needing the service Name of the person receiving the service * Gender of the person * - Select -He/HimShe/HerThey/ThemOther Primary disability of person needing the service * - Select -Behavioural-Autism-ADHD-ODD-OCDIntellectual/Developmental-Intellectual-Down Syndrome-Developmental DelayNeurological-Stroke-Neurological/Epilepsy-Multiple Sclerosis-ABIPhysical-Spinal Cord Injury-Muscular Dystrophy-Cerebral Palsy-Spina bifidaPsychosocial/Mental HealthEarly InterventionChronic Medical ConditionsHearing LossVision Impairment This is important so that we can find Providers that have specific experience where possible Do you identify an Aboriginal or Torres Strait Islander? * - Select -YesNo Participant Name Age of person needing the service * How is the NDIS plan managed? * - Select -I don't have an NDIS planAgency ManagedPlan ManagedSelf ManagedNot specified Where are you on your NDIS Journey? * - Select -Applying for the NDISPreparing for my Planning MeetingJust received my first NDIS planHave an NDIS plan for some timeComing up for a Plan (Review) ReassessmentNot eligible for NDIS fundingNot applicable Upload your plan (optional) Upload Our team can help you understand your plan if needed Provider Preferences Gender of Attendants Any Female only Male only Non-binary What additional language does the provider need to speak? AUSLANAlbanianAmharicArabicArmenianBosnianCantoneseCroatianDinkaDutchFarsiFijianFrenchGermanGreekGujratiHebrewHindiHungarianItalianJapaneseKoreanKurdishMacedonianMalayalamMandarinNepaleseOromianPortuguesePunjabiRomoRussianSamoanSerbianShinhaleeseShonaSomaliSpanishSwahiliTagalogTamilThaiTurkishUrduVietnameseYoruba Do you require help with these more complex needs? 24hr Care2: 1 supportAdministration of MedicineBehaviours of concernCatheterColostomy bagContinence AssessmentsDiabetesPEG feedingRegistered nurseTrachea careWound care Does the provider need any of these skills? AbscondingAdvocacyAfter School SupportAge CareBuild Technology SkillsCALD SupportChallenging BehavioursCrisis AccommodationCrisis ManagementDomestic ViolenceDrug & AlcoholHospital TransitionJusticeLearn to DriveLGBTQIA+Mental HealthNDIS ApplicationsNDIS Plan ReassessmentsPalliative CarePublic GuardianYouth Mentoring Specify any other skills the provider needs Tell us what services you need Select up to 5 different services in one request I am looking for * - Select -Support-Accessing the Community-Personal Care-Support Worker-Help with Daily Tasks-Nursing-MentorPlan Support-Plan Manager-Support Coordinator-Specialist Support Coordinator-Recovery Coach (PRC)-PBS ManagementAllied Health (Therapies)-Functional Capacity Assessment (FCA)-Art Therapy-Counselling-Developmental Educator-Dietician-Exercise Physiology-Key Worker-Music Therapy-Occupational Therapy-Physiotherapy-Podiatry-Positive Behaviour Support Plan-Psychology-Psychotherapy-Social Worker-Speech Therapy-Therapy Assistant-Other Therapy (Sand, Animal, Play)Home Maintenance-Cleaning-Gardening-Yard Maintenance-Handyperson & RepairsHousing-ILO-Medium Term Accommodation-Specialist Disability Accommodation (SDA)-Supported Independent Living (SIL)-Home ModificationsSocial, Health & Wellbeing-Social Activities and Programs-Respite/Short Term Accommodation-Family & Peer Support Groups-Holistic Therapy-Personal TrainingSkills Development-Budgeting & Finance-Driving Lessons-Computer Skills-Mentoring-Travel TrainingEmployment-Support in Employment-Finding and Keeping a Job-SLES (Registered Provider)Equipment-Consumables-Disability AidsChildren-Early InterventionSomething else (let us know what) What do you need the Support Worker to help with? Accessing the community (includes social activities in the community)Help with personal careSupport with daily activitiesHelp with cooking and meal prepHelp finding accommodationHelp learning to use public transportHelp with job search and interviewsAfter school supportHelp with transport Most popular Support Worker Support Coordinator Plan Manager Cleaning Occupational Therapist Tell us about the support you need Is there more about your needs that you would like to tell us? Service Details How do you need the services delivered * Any At provider's premises Mobile Online When do you need the service * - Select -ASAP1 week2-4 weeks1-3 months3-6 monthsMore than 6 months How many hours do you need weekly (estimated) * - Select -Not applicable1 hour2 hours3 hours4 hours5 hours6 hours7 hours8 hours9 hours10 hours12 hours24 hours How frequently do you need the service * - Select -Not applicableOne offDailyWeeklyFortnightlyMonthly What type of assessment do you need? - None -Diagnostic AssessmentDriving AssessmentEmployment AssessmentFunctional Capacity AssessmentHome Modification AssessmentHousing AssessmentMobility AssessmentPositive Behaviour AssessmentPostural AssessmentSensory AssessmentSwallowing Assessment Service Details How did you find us? * - Select -Expo/EventSchoolUsed MyCareSpace beforeAdvert on a BusAMAZE WebsiteAdvert in a GPAutism ConnectFacebook - saw an advertFacebook - submitted an enquiryGoogle SearchBing (Windows) SearchFriend or family memberDoctor or therapistSupport CoordinatorNDIS LACService ProviderSupport PortalMCS Community EngagementWord of mouthOther Would you consider using Teletherapy? * - Select -YesNo Something else I need is... 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