Refer a participant
to Health on call

A simple, professional referral process for participants, families, Support Coordinators and health professionals.

Nurse-led | Responsive | Participant-focused

Referrer Details

Full Name

Role/Relationship to the patient

Phone number

Organisation

Email

Participant Details

Participant Full Name

Suburb/Postcode

Participant phone

Preferred Language

Preferred Contact Person

Date of Birth required

NDIS number (optional)

Participant Email

Communication needs or preferences

NDIS Plan Information

Plan Manager / Support Coordinator

Plan start date required

Plan end date required

What support is required?

Support Requirements

Days support is required

Preferred commencement date required

One-to-one support?

Yes

No

Two-to-one support?

Yes

No

Preferred worker gender (if relevant)

Approx. hours per week

Is support urgent?

Within 24-48 hours

Within 1 week

Within 2-4 weeks

Flexible

Overnight support?

Yes

No

Active overnight / sleepover?

Yes

No

Cultural or language preferences

Clinical and Safety Information

Complex health needs?

Yes

No

Mobility assistance required?

Yes

No

Manual handling required?

Yes

No

Behaviour support plan?

Yes

No

Restrictive practices involved?

Yes

No

Unsure

Allergies or important health information

Known risks staff should be aware of?

Additional information about the participant's needs

Supporting Documents (Optional)

Upload NDIS Plan

Upload Support plan

Upload Behaviour support plan

Upload Clinical care plan

Upload other documents

Consent

I confirm that I have authority or consent to submit this referral and share the information provided with Health On Call.

I agree that Health On Call may contact me regarding this referral..

Refer a participant to Health on call