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Please fill out the below referral form so that we can learn more about you and how we can provide you support.

Referee Info


Living Arrangements*

What type of activities are you interested in? *

Currently Attending



Referral Information

Who is responsible for signing this Service Agreement:

Expected Outcomes

Expected outcomes from Service

Documents to help provide support - Upload all that apply

Upload all relevant documents including:

  • Health care plans

  • Mental health care plans

  • Person Lifestyle Plan

  • Relevant medical reports

  • Psychology reports

  • medication charts

  • Risk profiles

  • And a copy of NDIS Plan Participants goals.

Upload Files


NDIS Plan Details

NDIS Plan*

Support Categories:

Increased Social & Community Participation

(CB Social Community Civic)*

Core Supports (If above not available)*

Is the Participant NDIA or Plan Managed?*

If Applicable: Name & Contact Details of Plan Managers & email for invoicing


This information will be used to inform allocation of support and it will be stored securely by Authentic Support. Should you decide to not use Authentic Support, your hard copy and soft information will be destroyed.

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