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Quick Intake Form

Get the Right Support for Your Needs

Expression of Interest Intake Form

Complete the Expression of Interest/Referral form, and our team will be in touch to arrange a meeting.

We’d love to learn more about you and how we can help.

1. What are your details (applicant)?
2. If someone else is filling out this form, what are their details?
3. Describe your disability(s)?
4.What is your current NDIS status?
5. Please provide any additional medical support needs.
6. How are your supports currently managed?
7. Other team supports
8. What are your interests and the type of services that you require?
Representative or Emergency Contact Details

If you would like to fill out a more in-depth intake form which allows us to further personalise our services to fit your needs please download the Full Intake Form here and email it to: support@assistlifestyle.com.au

If you would like to learn more about our services please download the PDF Brochure here

If you are interested to see our processes, operation policies, and procedures please download the Participant information booklet here

Assist Lifestyle acknowledges the Traditional Custodians of country throughout Australia and their connections to land, sea and community. We pay our respect to their Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today. We also acknowledge the diversity of Australian culture and extend our support to all individuals, regardless of culture or sexuality.