Referral | Amiza Care

NDIS Intake Registration

Participant Referral Form

Please complete the form sections below to submit a referral to our intake team.

Participant name

Participant suburb

Contact person

Contact role

Contact email

Contact phone

Funding or plan type

NDIS number

Requested support

Urgency

Participant goals and what support should achieve

Risks, health needs, behaviour support or access information

Communication preferences

Preferred days or times

Consent and people approved for contact

Consent Confirmation

I confirm I have consent or authority to share this referral information with AmizaCare.

Intake Channels

support@amizacare.com

+61 481 907 342

Turnaround Time

Our support coordinators will review NDIS and pathway details and contact you within 1-2 business days.

AmizaCare is not an emergency triage. In immediate danger or medical crisis, call 000.