Referral form for participants

Alternative Contact


(in case the participant or Support coordinator is unreachable)

Please provide the primary physical disability or psychological disability and a brief medical history (eg: Intellectual Disability, Cerebral Palsy, Multiple Sclerosis)

Occupational Therapy ONLY

We will work with you to select the most appropriate option.
a2z Health Group charges the rate of $193.99 per hour and $96.99 per half hour travel
If you selected Plan Manager or Self Managed, please complete the following details:
Following receipt of your referral we will put together a Service Agreement. This will help you understand how we will support you towards your goals and the associated costs.
Please note: a2z Health Group follow NDIS guidelines for Short Notice Cancellations by which 2 clear business days' notice is required for changes to appointments, cancellations and/or missed appointments.