FOR THERAPISTS AND REFERRING PROFESSIONALS

Refer a participant

Their interests. Your expertise. Our support between appointments.

Your client chooses the Interest Based Supports they would like to explore. You can make a basic referral without sharing goals, strategies or a report. We manage our own team and service.

Retain your professional independenceShare information only if usefulComplete everything online

01 About you

These are your professional details, separate from the participant’s contact.

Your name Practice or organisation Your email Your phone (optional)

Your profession or role Preferred written reply

02 The participant and their choice

Only refer with the participant’s permission, or permission from someone with relevant legal authority. If permission has not been given, share our participant enquiry form with them instead.

Participant’s first name Participant’s last name (optional) Name they prefer us to use Age range

Do they already receive support from NE? Session type

Choose current sessions

Select the sessions the participant would like to attend. Times and availability come from our live timetable. Full sessions can be selected for the waitlist.

Loading current sessions…

Please help the participant choose, or discuss an interest that is not currently listed. Other interests or preferences (optional)

We can gather interest for a new session through a waitlist. School holiday options are available through our participant enquiry form.

Preferred start date (optional)

Your session choices go into our intake and booking process. Places, start dates and any waitlist arrangements are confirmed through that process.

Funding, if known Plan management, if known

03 Who should we contact?

Use the participant’s own contact details or their chosen, authorised contact. Please do not put your professional email in these fields.

I do not have their contact details yet. Please ask me for them.

Contact person’s name Relationship to participant Their email Their phone

If you provide a phone number only, our team will help arrange online intake. We will not use your email as the participant’s portal login.

How do they prefer us to communicate? Communication or access needs (optional)

Before we schedule

Share only what you have permission to share. You can leave these answers blank; we will confirm missing support information with the participant before scheduling.

Is there any health, safety or support information NE needs before scheduling? Is there a behaviour support plan in place now? Is anything used to restrict the person’s movement or access to keep people safe, such as holding, locked doors or equipment? Relevant support information (optional)

04 Information sharing is optional

Our team can work with the participant’s goals independently. You do not need to send us a therapy programme or supervise our workforce.

I would be interested in receiving NE’s structured observations, with the participant’s consent. I may share relevant goals or strategies where that would be useful. I would like a written discussion about collaboration. I would like referral progress updates if the participant agrees.

These are your preferences, not the participant’s permission. NE confirms permission before sharing participant information with you. Consent to a referral does not automatically authorise reports or ongoing updates.

I have permission to include relevant goals or strategies below. Anything you would like NE to respond to? (optional)

05 Permission and submission The participant, or a person with relevant legal authority, agrees to this referral, the details provided to NE, and NE contacting them about support.

Who gave permission? Their relationship or authority

Date permission was given How was it given?

I understand NE will use these details to manage this referral and contact the participant and me, as described in the Privacy Policy.

NE stores the referral securely in its existing intake system. Some systems store information overseas. Share only the information needed for this referral. The Privacy Policy explains access, correction and privacy complaints. You can contact us on 0468 005 012.

Fields marked * are required. There is nothing to print, sign on paper or scan.

Refer a participant

Choose current sessions

Before we schedule

Thank you for the introduction.