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Home » Make a Referral » OT & Psychology Referral

Participant Referral: OT & Psychology

Make a Referral

NDIS support team assisting with referrals and participant intake

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Step 1 of 7 - Participant Details

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Participant Details

First Name*

Last Name*

Date of Birth

Gender

Is the participant...

Torres Strait Origin

Aboriginal

Culturally And Linguistically Diverse (CaLD)

None of these

Language

English

Interpreter required

Auslan

Assistive technology

Other

Please list (other language)

Email

Phone

Address

Primary Diagnosis/Disability

Secondary Diagnosis/Disability

Status

Children

Living Situation

Guardian/Primary Carer Details

First Name

Last Name

Email

Phone

Relationship to participant

Address

Is this an emergency contact?

Referrer Details

First Name*

Last Name*

Email*

Phone*

Organisation*

Position*

Address

How did you hear about Sunflower Services?

Please list

Who?

NDIS Details

NDIS Number

Plan Start Date

Plan End Date

Funding available in plan

Hours of support per week

Upload NDIS Plan (if applicable)

Max. file size: 10 MB.

Introduction to Participant

Which service does the participant require?*

Occupational Therapy

Psychology

General Information

Presenting Risks/Complexities

Is the Participant supported by only one worker?

What are the Participant's Short-Term NDIS goals?

What are the Participant's Long-Term NDIS goals?

Does the Participant have any allergies?

Please explain...

Does the Participant have any Health/Medical conditions?

Please explain...

Participant's preferred method of communication

Texting

Calling

Email

Other

Please explain...

Participant's living arrangements

Is the Participant at risk of choking, seizures, or anaphylaxis?

Is the Participant under Public Guardian?

Is the Participant under care of the minister?

Is the Participant under TAG (Trustee and Guardian)?

Plan nominee?

Is assistance with medication and medication administration required?

Please explain and list medication...

Home Safety Risk Assessment

Is the home easy to locate?

Is onsite parking available for support workers?

Are there any slip, trip or falling hazards outside or inside the home?

Please explain...

Is there a pet or pets?

Is there poor phone reception at the home?

Is there a clearly designated entrance and exit for staff to access the home?

Please explain...

Is the Participant at risk of absconding?

Does the Participant require a two-person visit for safety reasons?

Are there any safety concerns Sunflower Services need to be aware of?

Final Steps

How is the participant managed?

Plan Manager Company Name

Plan Manager Name

Plan Manager Email

Plan Manager Phone

Additional Comments

Upload Behaviour Management Plan (if applicable)

Max. file size: 10 MB.

Upload OT Assessment (optional)

Max. file size: 10 MB.

Upload Risk Assessment (optional)

Max. file size: 10 MB.

Upload any other relevant collateral (optional)

Max. file size: 10 MB.

Do you wish to join our email list to receive newsletters, uplifting stories, and updates on our services, including Supported Independent Living (SIL) and NDIS accommodation options?

Has the participant/guardian consented to this referral?*

Helping People Live

Meaningful, Connected Lives

Acknowledgement

Sunflower Services acknowledges Aboriginal and Torres Strait Islander peoples as the First Peoples of Australia and we pay our respects to their elders past, present and future who we share this great region with.

Diversity Commitment

Sunflower Services is committed to embracing diversity and eliminating all forms of discrimination in the provision of health services. We welcome all people irrespective of ethnicity, lifestyle choice, faith, sexual orientation and gender identity.

Find Us

Newcastle Lot 1/37 Fern St, Islington NSW 2296

Gold Coast 1 Kortum Dr, Burleigh Heads QLD 4220

Adelaide Unit G/5 Butler Bvd, Adelaide Airport SA 5950

Contact Us

(02) 4030 1352
[email protected]

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Working Hours

Monday – Friday

8:00am – 5:00pm

Services

Support Work
Support Coordination
Psychosocial Recovery Coaching
Occupational Therapy
Psychology
Supported Independent Living (SIL)
Individualised Living Options (ILO)
Respite Care
Mentoring
Specialised Substitute Residential Care (SSRC)

Support Work
Support Coordination
Psychosocial Recovery Coaching
Occupational Therapy
Psychology
Supported Independent Living (SIL)
Individualised Living Options (ILO)
Respite Care
Mentoring
Specialised Substitute Residential Care (SSRC)

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About

About Us
Meet The Team
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About Us
Meet The Team
Join Us

Resources

Useful Resources
NDIS Price Guide
Staff Login

Useful Resources
NDIS Price Guide
Staff Login

ABN: 59 650 992 635
NDIS Registration Number: 4050091156
NDIS Registration ID: 4-GENT2FA

Acknowledgement

Sunflower Services acknowledges Aboriginal and Torres Strait Islander peoples as the First Peoples of Australia and we pay our respects to their elders past, present and future who we share this great region with.

Diversity Commitment

Sunflower Services is committed to embracing diversity and eliminating all forms of discrimination in the provision of health services. We welcome all people irrespective of ethnicity, lifestyle choice, faith, sexual orientation and gender identity.

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