Refer to DTC Care — NDIS referral

NDIS referral form

For health professionals, support coordinators, family and friends — or participants referring themselves. It takes about three minutes. We only need a name and a way to contact you; everything else helps us reply faster.

About you (the referrer)

Referrer nameHow do you know the participant?Referrer contact numberReferrer email address

About the participant

Participant nameParticipant contact numberParticipant email address

Services required

Funds management

NDIA managedPlan managedSelf managed

When and how much

When would you like our support to commence?How many hours would you like per day selected?

Preferred days

Anything elseHow did you find out about us?Anything we should know before we call? (optional)

Privacy collection notice

Welfare Services Pty Ltd (ABN 21 663 582 241) trading as DTC Care collects the personal information on this form to respond to the referral, assess whether we can provide the supports requested, and contact the referrer and the participant about them.

It is stored securely in Australia in the DTC Care portal and is seen only by the DTC Care staff who handle referrals. We do not sell it, we do not use it for marketing, and we do not enter it into artificial-intelligence tools.

We may share it with the participant's nominee, plan manager or support coordinator when that is needed to arrange supports, and otherwise only as the law requires. If information is left out, we may not be able to respond to the referral.

Our Privacy Policy explains how to see or correct the information we hold and how to make a complaint. Questions: prakash@dtccare.com.au or +61 426 803 524.

The participant (or their nominee or guardian) knows about this referral and agrees to DTC Care contacting them. If I am the participant, I agree.I have read this privacy collection notice and agree to DTC Care collecting and handling this information as it describes.

Before sending, this needs a name — either the participant's or the referrer's; a phone number or an email address, so someone can reply; confirmation that the participant knows about this referral; your agreement to the privacy notice.