Make a Referral | Legacy Disability Support

Referral Information: We accept referrals from: Support Coordinators, Hospital discharge teams, SIL providers, Plan Managers, Allied health professionals, Families and self-managed participants. All information is treated in strict confidence.

Section 1: Your Details (Referrer)

First Name *

Last Name *

Organisation / Company *

Your Role / Position

Email Address *

Phone Number *

Section 2: Participant Details

Participant First Name *

Participant Last Name *

Date of Birth

NDIS Number (if known)

Participant Suburb / Area *

Participant Contact Number (or Carer/Guardian)

Section 3: Required Services

Services Required * (select all that apply)

Community Nursing Care High Intensity Supports Personal Care & Daily Living Transport & Community Access Household Tasks Life Skills & Capacity Building Social & Community Participation SIL Support & RN Oversight Group & Centre Activities

NDIS Plan Management

Urgency

Additional Information / Background

By submitting this form, you consent to Legacy Disability Support storing and using the information provided to process this referral in accordance with our Privacy Policy.

Referral Received! Thank you — a member of our team will be in touch within 1 business day to discuss the next steps.

Prefer to Call?

Our referral team is available Monday to Friday, 8:30am–5:30pm.

0492 029 836

Email a Referral

Send referral documents directly to our intake team.

info@legacydisabilitysupport.com.au

What We Need

Participant details
NDIS number
Support needs
Risk information
Contact details for coordinator or family

What Happens Next?

We review your referral within 1 business day

Our coordinator contacts you to discuss the referral

We reach out to the participant to arrange a welcome meeting

Support commences, and we keep you updated

Refer a Participantto Legacy