Refer a Participant

NDIS Referrals

Submit a referral for a participant who needs NDIS support. Our team will review your referral and be in touch promptly.

Online Referral

Submit a referral online

Complete the form below to refer a participant to My Simple Support. Fields marked * are required. Our team will be in touch with you and the participant promptly.

Our service area: We proudly support participants across the Fairfield, Liverpool and Bankstown LGAs — including Cabramatta and surrounding suburbs. Our team includes Vietnamese-speaking support workers and coordinators.

In an emergency, call 000 This form is for referrals and general enquiries only. If someone is in immediate danger, please call Triple Zero (000).

About you (the referrer)

Your full name *

Role / Title *

Organisation (if applicable)

Relationship to participant *

Phone *

Email *

Participant details

Participant full name *

Date of birth *

Phone / mobile

Suburb *

Postcode *

NDIS number *

Plan management type *

Plan manager details

Plan manager / organisation *

Plan manager phone

Plan manager invoicing email

Current living arrangements

Preferred language / communication needs

Safety & additional information

Health, safety or medical considerations

Additional notes

Supporting documents (optional)

Attach any relevant reports or plans to help us prepare for the participant's support. Accepted formats: PDF or Word (.doc, .docx).

Behaviour Support Plan

Drop file here or browse PDF or Word document

Allied Health Reports

Drop file here or browse PDF or Word · up to 3 documents