Refer To Us – Mount Gollis Care & Services

Trusted Registered NDIS Provider

Refer

to Us

Know someone who needs support? Refer them to us, and we’ll provide the personalised care they deserve.

Referrer Details

Are you submitting this referral for yourself?

No, this referral for is for someone else Yes, this referral form is for me

Do you have consent from the person that you are referring or their representative to share the information in this form?

Yes No

Referrer Name

Referrer Email

Referrer Phone

Participant Details

Client Name

Client Address

Mobile

Date of Birth

Gender

Male Female Other

Other Details

Reason for Referral

What is the persons disability and support needs?

Is the client a participant of the National Disability Insurance Scheme?

Yes No Unsure

NDIS Participant Number

NDIS Plan Start Date

NDIS Plan End Date

Plan Management

Plan Managed Self Managed NDIA Managed

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Mon-Sat: 8am-5pm

Office Hours

About Us

At Mount Gollis Care & Services, we are devoted to ensuring you receive the care and support needed to achieve your best possible well-being.

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Talk to us today to discuss your goals and let us tailor our support to your needs.

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Acknowledgement to the Country

We acknowledge the traditional owners of country throughout Australia, and their continuing connection to land, sea and community. We pay our respects to them and their cultures, and to elders both past and present.