NDIS New Referral Form – Counselling/Psychotherapy

    A Life Simply Lived Psychology - NDIS Client Required Information - Counselling

     
    It is a requirement that this information is filled out prior to therapy commencement. Our clinicians must be aware of this information to ensure they are best matching the therapeutic goals with what the client needs, and also to keep the administration process running smoothly.
     
    Participant
     







     
    Plan Nominee Details (if not/ different to participant)
     




     
    NDIS Contact
     



     
    Support Coordinator Details (if applicable)
     




     
    Plan Management
     





     

     

     
    Disabilities (if unsure, please contact NDIS Support Coordinator)
     


     

     
    Allocated Funding
     
    Description
    Improved Daily Living Funds. Psychology – Assessment,
    Recommendation, Therapy and/or Training
    Item Reference Number
    15_043_0128_1_3
    Item Cost (hourly)
    $156.16





    (please select if it is known that participant will have an unplanned review)