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Make a referral

Home / Make a referral

Referrals · Western Sydney

Make an NDIS referral

Refer yourself, a family member or a participant you support. It takes about ten minutes, and our intake team usually gets back to you within one business day.

Start the referral

Call 0474 151 264

Referral form

Tell us about the referral

It takes about ten minutes. Fields marked * are required, and you can skip anything you are unsure about.

01Initial meeting

Preferred service location

Skillwise office (Rooty Hill) Phone or video call (Zoom etc.) Participant's home Other

02Referrer's information

Referrer first name

Referrer last name

Referrer phone number

Referrer email address

Referrer type

03Participant information

First name

Last name

Date of birth

NDIS number

Gender

Male Female Non-binary Transgender Prefer not to answer

Phone number

Email address

Address

Preferred language

Diagnosis and background

Documentation (please attach the most recent NDIS plan and any allied health and medical reports, if available)

04Risks and safety

Are there any court orders applicable? e.g. parole, apprehended violence order

Yes No

Has the participant ever been physically aggressive towards allied health, medical or support staff?

Yes No

Has the participant been incarcerated in a prison, juvenile detention centre or spent time in a forensic hospital for a violent or sexual offence?

Yes No

Is the participant currently engaging in alcohol or drug use?

Yes No

Are there any known risks for visiting the participant in their own home?

Yes No

Is there any other information we need to know? e.g. topics that may upset the participant, specific likes or dislikes

Yes No

If you answered yes to any of these, please tell us more

05Initial appointment

Who do we contact to arrange an appointment?

Who will be present at the appointment?

Address of the initial appointment

Appointment preferences

Preferred time No preference

Preferred day and time (if any)

06Service agreement

Who will sign the service agreement?

Participant / myself Referrer Advocate Guardian Someone else

07Payment method

How is the plan funded?

NDIA-managed Self-managed Plan-managed

08Further information

Relevant information not previously mentioned

How did you hear about Skillwise?

09Disclaimer

Consent

By submitting this referral, the referrer confirms they have the participant's consent to send it to Skillwise Disability Services for processing. See our privacy policy.

Contact

I agree that Skillwise will contact the person named in this form to arrange an appointment. If Skillwise cannot reach them, an appointment will be booked with at least one week's notice and everyone involved will be told by email and text message.

After you send it

Three simple steps

We call within one business day. Our intake team contacts the person you named to say hello and confirm the details.

A free first meeting. At home, at our Rooty Hill office or by phone, in the language that suits you.

Your support starts. We agree a service agreement together, match support workers and keep checking in.

Areas we support

Rooty Hill
Blacktown
Mount Druitt
Western Sydney

Skillwise Disability Services is a registered NDIS provider in Rooty Hill. We support people across Blacktown, Mount Druitt and Western Sydney at home, out in the community and at work.

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Visit or call

93 Beames Avenue, Rooty Hill NSW 2766
0474 151 264
info@skillwisedisability.com.au
Mon to Sat, 8am to 5pm. Sunday closed.

Skillwise

We acknowledge the Darug people, the Traditional Custodians of the land where we work, and pay our respects to Elders past and present.