Referrals

We pride ourselves on our exemplary performance within the NDIS and aged care sectors so it’s no surprise that we receive a lot of referrals.

We welcome the opportunity to support as many NDIS participants as we can.

To make a referral, simply fill in and submit the forms below and one of our client services officers will be in touch.

Making a Referral to The Dementia Foundation

Please fill out the following form

1Referring Details

2Client Details

Name(Required)

Prefix First Last

Email(Required)

If health professional, your organisation

Phone(Required)

Date of Referral

Is there a current NDIS plan in place?

What role best describes your relationship?

Please attach any medical/allied health reports, including NDIS plan if available

Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 128 MB.

What funds are available on the NDIS plan

Please enter NDIS funds available

Date the plan expires

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Date of birth

Participant

Preferred language

NDIS number

Does the client have any physical health conditions?

Does the client have a mental health condition?

Does the client have any behaviours of concern?

Please select the services you’re interested in:

Please describe your goals and preferences

Please add any additional comments/useful information here

Please tick how you heard of us