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About Us
Services
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Home
About Us
Services
FAQ’s
Contact

Home
About Us
Services
FAQ’s
Contact

NDIS Participant Intake

Personalised health and disability supports focused on your wellbeing, independence, and daily living needs.

This form helps Bluemates Health and Disability Solutions understand the support you are looking for and how we can assist under your NDIS plan. Participants, nominees and support coordinators can use this form to share key details such as support needs, plan information and preferences. Once submitted, our team will review the information and get in touch to discuss suitable supports and next steps.

Submitting this form does not mean services have started. It simply helps us prepare and respond to your enquiry as smoothly as possible. All information provided is kept private and used only to support NDIS service delivery. If you need any help completing the form, please contact our team; we’re happy to assist.

Participant intake form

Participant Full Name

Preferred Name

NDIS Number

Date of Birth

Gender

Male Female Non-binary Prefer not to say Other

Address

Phone Number

Email

Very Important:

If you are completing this form on behalf of the participant, please provide your details below. Otherwise, you may skip this section.

Full Name

Relationship to Participant

Phone Number

Email

Plan Management Type

NDIA Managed Plan Managed Self-Managed

Plan Manager Name

Plan Start Date

Plan End Date

Primary Disability or Diagnosis

Secondary Diagnoses (Optional)

Recommended:

You can select more than one option. This helps us understand the types of support you may need.

Current Supports Required (select all that apply)

Personal Care Daily Living Support Community Access Transport Overnight / Sleepover Support Nursing / Clinical Supports Behaviour Support Other

Other Support

This information helps us plan safe and suitable supports. You may leave any question blank if unsure.

GP Name and Practice

Medical Conditions

Medications

Medication List Upload

Allergies

Mobility

Sharing safety information helps us support the participant safely and appropriately.

Behavioural Risks (if any)

Manual Handling Risks (if any)

Falls Risk

Yes No

Seizures

Yes No

Other Safety Concerns

Participant Goals

Preferences

Name

Relationship

Phone Number

I consent to Bluemates Health and Disability Solutions collecting and using my information for the purpose of providing NDIS supports in line with privacy requirements.

I agree to the consent statement above

I consent

Participant or Nominee Name

Date

If you have any questions about this intake form or need assistance, please contact us. Our team is here to support you.

Phone:
0413 218 724

Email:
info@bluemates.com.au

54a Melbourne Street east Maitland NSW. 2323

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Our team of skilled nurses and support workers deliver personalised care tailored to meet your unique needs. Whether you need nursing services, NDIS support, or specialised forensic cleaning, we are here to help.

Registered NDIS Provider

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Blue Mates acknowledges the Traditional Custodians of the land on which we work and live, the Awabakal and Worimi people. We pay our respects to their Elders past, present, and emerging. We celebrate the continuing connection to land, sea, and community and extend that respect to all Aboriginal and Torres Strait Islander peoples today