Practitioner Referral Form

Lotus Disability Care Group is a NDIS provider group that supports clients with attaining and maintaining their NDIS packages. We provide Access services, Support Coordinators, Psychosocial Recovery Coaches, Support Workers, Domestic help and access to a variety of Allied Health Practitioners. We also provide workshops that help to build participant confidence, skills and to support developing relationships in the community.

To refer your patient/client, please complete the following referral and submit. We will be in touch via email to confirm any other details required.

"*" indicates required fields

Patient/Client Name*

Address*

Date of Birth*

Phone*

Email*

Person to Contact*

Phone*

Reason for referral*

NDIS Application

Support Coordination

Psychosocial recovery Coach

Support Accessie support worker, domestic care

Other

Client condition/Diagnosis*

Referring Practitioner Details

Practitioner Name:*

Provider Number:*

Business phone:

Email:*

Business Address:*

Date of referral:

Practitioner Referral Form

Referring Practitioner Details

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