Referrals - Enabled Care

Referral Form

To start your referral, please complete the details below and click "Submit" and we shall be in contact with you within 24 hours. Should you have any queries, please call us on 1300 731 247 (between 9am - 5pm AET Mon-Fri) or email info@enabledcare.com.au

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Consent - Do you have Legal Authority to sign up?

Yes, I am the NDIS participant
Yes, I am the plan nominee
Yes, I have legal consent from the NDIS participant

Participants Name

First

Last

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Phone Number

Participant Address

State

Date of Birth

Suburb

Post Code

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How is NDIS plan managed?

Plan start date

NDIS Number

Plan Manager Details (if applicable)

Plan end date

PACE Participant?

How are you associated?

Your Name

First

Last

How did you hear about us?

We will need a copy of your NDIS plan to set you up in our system. Please upload it below by "click or drag a file the below area to upload" or send it to us by email to info@enabledcare.com.au

Click or drag a file to this area to upload.

File Upload

Personal Information Collection Statement

To assist us (Enabled Care Pty Ltd - ABN: 54 650 962 637) in conducting our business functions and sending you regular communication, we need to collect personal information about you.
By providing your personal information, you agree to its use and disclosure in accordance with this statement and Privacy Policy. If you do not agree, you must not provide your personal information, and we may not be able to communicate with you or provide certain services to you.
We may disclose your personal information to other parties, including our website host or software application provider to operate our website, third parties who provide products and services to us or
through us, your authorised representatives/nominees, and representatives, agents or contractors who we appoint in the ordinary operation and administration of our business.

Our Privacy Policy is available here
It contains information about how you may access and seek correction of your personal information, how you may complain about a breach of your privacy, and how we will deal with that complaint.