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Refer an NDIS Participant

Help someone connect with support that’s right for them.

If you’re a support coordinator, healthcare professional, family member or carer, you can refer a participant to Care Cube using the form below.

As a registered NDIS provider, we offer personalised support across Ballarat, Melbourne, Geelong and other surrounding areas in Victoria.

Welcoming NDIS Referral Consultation.png

Complete the Referral Form

Tell us about the participant, their support needs and the services they’re interested in. Please make sure you have their consent or appropriate authority before sharing their information.

My relationship with the person needing disability support

First name*

Last name*

Phone*

Email*

Organization name

I confirm I have the participant’s consent, or appropriate authority, to share their information with Care Cube for this referral.

About the client

First Name*

Last Name*

Can the client be phoned? *

Yes

Gender*

Female

Male

High risk? *

Yes

Date of birth*

Street*

Suburb*

NDIS/COS / Private / Medicare*

NDIS #

Preferred language*

Interpreter required? *

Yes

Client Aboriginal or T.S. Islander? *

Yes

Diagnosis Living arrangements (Group home, support accomm, independent, family)*

Client plan details

Plan start date (please attach NDIS plan)

Plan end date

How is plan managed?

NDIA managed

Self-managed

Plan managed

Other

Plan manager's details*

Carer / Support / Guardian

My relationship with the person needing disability support*

First name*

Last name*

Phone Number*

Street*

Suburb*

State*

E-mail Address*

Communications contact

My relationship with the person needing disability support*

First name*

Last name*

E-mail Address*

Phone Number*

Support services required*

One on One Community Support

Short Term Accommodation

Garden Maintenance

Community Nursing Care

One on One Activities of Daily Living Support

Transport

SIL Accommodation

Assistance with Medication

Group Activities

Assist Access/Maintain Employ

House Tasks

Other

Get in Touch

Call Us

+61 473 795 773

Email Us

services@carecube.com.au

Service Areas

Ballarat, Wendouree, Sebastopol, Creswick, Ballan, Bacchus Marsh, Altona, Point Cook, Geelong, Melbourne and other surrounding areas in Victoria.

Victoria Surrounding Areas Map Care Cube NDIS.png

Ready to Start a Conversation?

Speak with the Care Cube team today.
The right support starts with understanding what matters to you.

Call: +61 473 795 773

Or Get in touch online →

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Contact Us

Acknowledgement of Country

Care Cube wishes to acknowledge the Traditional Owners of the lands on which we work and live, Australia’s First Nations people. We acknowledge the right of First Nations people to their traditional knowledge and cultural expressions. We commit to working collaboratively and ethically to increase First Nations inclusion in our business and the Australian Health and Disability sector.

Services

Community Participation
Recreational Activities
Respite Care
Supported Independent Living - SIL
Short Term Accommodation - STA
Community Nursing
Domestic & Personal Care