Make a referral

Start a support conversation

Provide the essential details below. Please do not include unnecessary medical records or sensitive documents at this initial stage.

1. Referrer details

Full nameOrganisationPosition or relationship to participantPhoneEmail

2. Participant details

Participant namePreferred namePhoneEmailPostcodeBest person to contactRelationship of contact person to participant

3. Funding information

Funding typeNDIS participant numberPlan manager name (where applicable)Plan manager contact detailsSupport coordinator name (where applicable)Support coordinator contact details

Swan River Care currently accepts self-managed and plan-managed referrals.

4. Requested support

Service or services requested*Community and social supportHousehold tasks and cleaningLife skills and independenceTransport and appointmentsTenancy and transition supportGardening and light yard maintenance

Reason for referralPreferred days and timesProposed commencement dateFrequency of support

5. Preferences and accessibility

Language spokenInterpreter required?Preferred communication methodCultural or religious preferencesWorker gender preferenceDietary preferences, including halal requirementsMobility requirementsCommunication requirementsRelevant safety informationAdditional notes

6. Consent