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Home
About Us
Services
Supported Independent Living
Life Skills Development Assistance
Household Tasks
Therapeutic Supports
Occupational Therapy
Speech Pathology
Positive Behaviour Support
Psychology
Day Programs
After School Programs
School Readiness Programs
FAQs
Careers
Blog
Contact Us
Intake Form
Referral Form
Feedback
Report an Incident
Book an Assessment
Home
About Us
Services
Supported Independent Living
Life Skills Development Assistance
Household Tasks
Therapeutic Supports
Occupational Therapy
Speech Pathology
Positive Behaviour Support
Psychology
Day Programs
After School Programs
School Readiness Programs
FAQs
Careers
Blog
Contact Us
Intake Form
Referral Form
Feedback
Report an Incident
Home
About Us
Services
Supported Independent Living
Life Skills Development Assistance
Household Tasks
Therapeutic Supports
Occupational Therapy
Speech Pathology
Positive Behaviour Support
Psychology
Day Programs
After School Programs
School Readiness Programs
FAQs
Careers
Blog
Contact Us
Intake Form
Referral Form
Feedback
Report an Incident
Begin Your Journey with Us
Intake Form
Participant's name
First name
Last name
Address
Address 1
Address 2
City
State
ACT
NT
NSW
QLD
SA
TAS
VIC
WA
Postal code
Country
Australia
Date of birth
Contact phone number
Contact email
Preferred method of contact
Email
Phone
Text
Support coordinator
Other languages
Aboroginal and/or torres strait
Yes
No
Please upload your NDIS plan here
NDIS number
NDIS start date
NDIS end date
Do you have a support coordinator?
Yes
No
Cultural needs
Support coordinator's name
First
Last
Support coordinator's number
Support coordinator's email
Is your NDIS plan
NDIA managed
Plan managed
Self managed
No plan
NDIS plan manager name
NDIS plan manager email
NDIS plan manager phone number
Reason for seeking Infinite Care 365
Days you would like support
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Unsure
All of the above
Hours you would prefer
Morning 8AM - 12PM
Afternoon 12PM - 5PM
Evening 5PM - 9PM
Night 9PM - 12AM
Overnight 9PM - 8AM
Unsure
Hours of support each shift (estimated)
Specific times if not listed and any additional comments
What can we support you with? Choose as many as you like. If you're not sure yet, click "unsure."
Support coordination
Personal care (showering, etc)
Companionship
Cleaning
Transport
Cooking
Housing
Finding a job
Support to activities/appointments
Exploring new activities
Medication assistance
Help in times of need/crisis
Speech Therapy
Occupational Therapy
Behaviour Therapy
Psychology
Counselling
Play Therapy
Group Therapy
Day/ After School Programs
Unsure
Do you have preferences for your worker? For example: male, female, age.
Yes
No
If yes, please specify your preferences
Are there any safety concerns, contact restrictions, behavioural concerns, or other risks, that we should be made aware of?
Yes
No
If yes, please specify
Health (clinical diagnosis)
Medication (if relevant on shift)
Medication type
Times to be taken
Current extra curricular activities or hobbies
Do you have a companion card?
Yes
No
Any behaviours you would like us to be aware of?
Any triggers you would like us to be aware of so we can avoid them?
Any phobias/anxieties you would like us to be aware of so we can help avoid them?
Do you have any strategies you use, when you feel you need them, that can help the support worker assist you in times of need?
Any additional comments
Send
Enquire Now
Name
Phone
Email
Post Code
Select The Service You Require
Select the service you require
Daily personal activities
Household tasks
Development of daily living and life skills
Assistance in coordinating or managing life stages, transitions, and supports
Assistance with daily life tasks in a Group or shared living arrangement (SIL)
Assistance with travel/transport arrangements
Participation in community, social & civic activities
Group and centre-based activities
Innovative community participation
Assistance to access and maintain Employment or higher education
Therapeutic supports
Early intervention support for early childhood
Other
Send
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