My Disability Support Services (My DSS) – Participant Intake Form

    Referral Details

    Date of Referral

    Participant Details

    NDIS Plan Start Date

    NDIS Plan End Date

    Date of Birth


    Contact Details



    List all Doctors and their contact details:

    *Specialty = GP, OT, Psychologist, Physiotherapist, Behaviour Support Practitioner, Speech Therapist, or Other (please specify)

    Please download the below My DSS Client Consent Form by clicking the link below and get it signed by the participant to get started with your referral request. Please email this consent form to once signed by the participant or their guardian.

    Download Here
    Click Here..!

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