Referrals

Make a referral

Refer yourself or someone you support for Support Coordination and Connection Services in Western Australia. It takes about five minutes, one short question at a time, and we will be in touch once we've reviewed it. Prefer email? Send the details to contact@felixscc.au.

About you

Tell us who is making the referral so we know who to follow up with.

Who is making the referral?

First name Last name

Organisation (optional) Role or relationship to participant (optional)

Email Phone (optional)

The participant

The person who would receive Support Coordination. If you are referring yourself, enter your own details again.

First name Last name

Preferred name (optional) Date of birth

Phone (optional) Email (optional)

Suburb (optional) Best way to contact them (optional)

What is the primary concern?

In your own words is perfect. Share as much or as little as you're comfortable with.

Primary concern

Why are you making this referral?

Tell us why Support Coordination is needed now, and what a good outcome would look like.

Reason for referral

Any special requirements?

Anything that helps us work well with the participant. Skip this if there's nothing to add.

Special requirements (optional)

Are there any risk factors?

Anything that affects the safety of the participant, our staff or others. Skip this if there's nothing to add.

Risk factors (optional)

Anything else we should know?

Skip this if there's nothing to add.

Additional notes (optional)

Funding

Support Coordination needs to be funded in the participant's NDIS plan.

How is the plan managed? Participant's NDIS number

Plan start date (optional) Plan end date (optional)

Plan manager (optional) Send invoices to (optional)

Review and send

Check the details below. Use Edit to change anything.

We handle referral information in line with our privacy policy.

Felix SCC Pty Ltd · NDIS Provider Number 4050175178 · ABN 86 702 398 196 · Perth, Western Australia

Make a referral

Thanks, we've got your referral