Prior to your first NDIS Session, please complete the following form which provides us with the information to tailor a package which is both appropriate and safe. This will also be used to create an account in our system should you wish to continue with regular sessions. Please also refer to our Privacy Policy.

Client

Person with disability

Responsible Person

Name of parent, guardian with primary care responsibility for the client

If you have a plan manager, they will always receive the invoices - in this case, indicate here whether you would like to receive a copy. If you don't have a plan manager, you will always receive the invoices.

Regular Carer

Contact details of regular carer who will accompany the client

Tick yes if a regular carer will accompany the client for each session

Plan Manager

Organisation responsible for administering NDIS plan and payment of invoices

Tick yes if the client has a plan manager

Medical and Behavioural Issues

Please supply as much information as possible to ensure that we can tailor an appropriate and safe program for the client.

Please provide a description of any known medical issues that could lead to problems in a farm environment. Include Known conditions for which medication is given regularly, bleeding abnormalities, allergies, physical disabilities, etc.

Please provide details of any tendencies that would not be regarded as "normal" such as anxiety, reactions to events, tendency to run/hide, phobias, etc.

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