Please provide Participant direct email and phone number.
If the contact information is for a different person, please complete on the following page.
The Service Agreement will be sent to this person for authorisation.
The Service Agreement will be sent to the Participant for authorisation.
Protecting your Privacy
Rights and Responsibilities
Click here to view our Client Rights and Responsibilities
You may share my details with an NDIS approved auditor for NDIS audit purposes.
If we cannot collect and share your details with other providers, we may not be able to properly provide you with Supports. You can choose not to share your details with an auditor now or later. Ask us if you have questions.
When you record AccessHC as a provider on your plan, you are letting the NDIA know that AccessHC can make claims against your NDIS plan when we deliver a support to you, this way the NDIA won’t have to check with you before they pay us.
The following information needs to be completed with as much detail as possible. This information determines the suitability of the referral to our services. Referrals may be delayed if adequate information is not supplied initially.
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