If you or you know of someone who can benefit from the services we provide, please provide us with the NDIS Participant and Plan details in the below ESS intake form. We will be glad to assist in the best way we can.
Is the participant of Aboriginal or Torress Strait Islander decent?
*Is there a behavioural support plan in place? (if yes please attach)
Is the participant able to mobilise independently or is assistance required?
Does the participant require assistance with any of the below? (please select all that apply)
*Relationship to the Participant
*Services required (click all that apply)
We like to use photos of our Activities/ Groups on our social media and our website, do you consent for your/participants photos being used for this?
To provide you with high quality and safe services, sometimes Elite Support Services QLD may need to collect and use some of your personal information. We need certain personal information to:
work within the context of your/participants NDIS plan, budgets, and goals.
understand what you/participant want and need from us, and sometimes others, to provide you with quality and safe services. To do this we require consent.
*Do you give consent to Elite Support Services QLD to access information from NDIA/Support Co-Ordinator/Plan Manager regarding to your/participant’s NDIS plan that will be used to provide the support?
I confirm that:
I understand I can get further information about how the NDIA handles my personal information from the Privacy Notice or Privacy Policy on the NDIS website.
I understand I have given the NDIA consent to give information about me/participant to the Elite Support Services QLD so they can take the identified action/s on my behalf.
I understand I can withdraw or change my consent to share information and/or my permission for a third party to act on my behalf at any time.
I confirm the information provided in this form is complete and correct.
I understand giving false or misleading information is a serious offence.
I understand this information is protected by law and can only be given to someone else where Commonwealth law allows, or requires it, or where I give permission.
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