Make a referral

At Ability Action Australia, we make it easy for you to request our services. There is a range of information that we need from you in order to commence, so we provide you with two options:

Complete a full referral form, where you provide us with all the information needed to get you set-up and ready to go

Complete a partial referral form, where you provide us with just some of the necessary information. Then, once we receive your form, we will contact you via telephone to get the additional information.

At any stage our Concierge Team are ready and willing to help you. Simply call us on 1800 238 958 or email us at hello@abilityactionaustralia.com.au

Let’s get started

Full referral form

Full Referral Form

Your details
General information
About your disability
Services required
Consent and payments

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Your role *

Your first name *

Your last name *

Your phone number *

Your email address *

Your company

Your position title

Participant details

Participant’s first name *

Participant’s last name *

Your participant NDIS number *

Participant NDIS number *

Date of birth

Your date of birth *

NDIS Plan start date *

NDIS Plan end date *

Phone number *

Email address *

Gender

Your address *

Address *

State *

Postcode *

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Partial referral form

New Referral Form

Your role *

Your first name *

Your last name *

Your phone number *

Your email address *

Your company

Your position title

Participant details

Participant’s first name *

Participant’s last name *

Your participant NDIS number *

Participant NDIS number *

Date of birth *

Your date of birth *

NDIS Plan start date *

NDIS Plan end date *

Phone number *

Email address *

Gender *

Address *

State *

Postcode *

Disability background

It would be very useful in identifying goals and funding type if you could share your NDIS plan with us (or relevant pages from that plan). Please upload it here

Maximum upload size: 67.11MB

Primary disability *

Services required

What service(s) does the participant require?

Occupational Therapy

Physiotherapy

Exercise Physiology

Occupational Therapy *

Functional Assessment

Assistive Technology Assessment Level 1 and 2

Assistive Technology Assessment Level 3 and 4

Home Modifications Assessment

Specialist Disability Accommodation Assessment

Supported Independent Living Assessment

Paediatric Assessment

Therapy

Occupational Therapy Driving Assessment (Western Australia only)

Physiotherapy *

Physiotherapy Assessment

Physiotherapy

Ability Action Australia provides Functional Assessments at the NDIS gazetted rate of $193.99 per hour. While the total cost will depend on the time taken to complete the assessment, it is estimated that this would be a maximum of 10 hours.

Ability Action Australia provides Assistive Technology Assessments Level 1 and 2 at the NDIS gazetted rate of $193.99 per hour. While the total cost will depend on the time taken to complete the assessment, it is estimated that this would be a maximum of 10 hours.

Ability Action Australia provides Assistive Technology Assessments Level 3 and 4 at the NDIS gazetted rate of $193.99 per hour. While the total cost will depend on the time taken to complete the assessment, it is estimated that this would be a maximum of 15 hours.

Ability Action Australia provides Home Modifications Assessments at the NDIS gazetted rate of $193.99 per hour. While the total cost will depend on the time taken to complete the assessment, it is estimated that this would be a maximum of 20 hours.

Ability Action Australia provides Specialist Disability Accommodation Assessments at the NDIS gazetted rate of $193.99 per hour. While the total cost will depend on the time taken to complete the assessment, it is estimated that this would be a maximum of 15 hours.

Ability Action Australia provides Supported Independent Living Assessments at the NDIS gazetted rate of $193.99 per hour. While the total cost will depend on the time taken to complete the assessment, it is estimated that this would be a maximum of 15 hours.

Ability Action Australia provides Paediatric Assessments at the NDIS gazetted rate of $193.99 per hour. While the total cost will depend on the time taken to complete the assessment, it is estimated that this would be a maximum of 10 hours.

The cost of Therapy services will depend on the session occurrence, travel and mode of delivery (face-to-face or via telehealth). All therapy services are provided at the NDIS gazetted rate of $193.99 per hour and are estimated to take up to 20 hours in total.

Ability Action Australia provides Occupational Therapy Driving Assessments at the NDIS gazetted rate of $193.99 per hour. While the total cost will depend on the time taken to complete the assessment, it is estimated that this would be a maximum of 10 hours.

Ability Action Australia provides Physiotherapy Assessments at the NDIS gazetted rate of $193.99 per hour. While the total cost will depend on the time taken to complete the assessment.

The cost of Physiotherapy services will depend on the session occurrence, travel and mode of delivery (face-to-face or via telehealth). All physiotherapy services are provided at the NDIS gazetted rate of $193.99 per hour.

The cost of Exercise Physiology services will depend on the session occurrence, travel and mode of delivery (face-to-face or via telehealth). All therapy services are provided at the NDIS gazetted rate of $166.99 per hour and are estimated to take up to 10 hours in total.

Please provide GP details (if known) to enable us to obtain medical clearance to safely deliver these services:

GP name

Medical centre name

Phone number

Travel costs for all services are charged as per the Modified Monash Model.
MM 1-3 allow for travel up to a maximum of 30mins 1 way
MM 4-5 allow for travel up to a maximum of 60mins one way
MM 6-7 travel allowance determined with relevant parties

Consent & payments

Consent and payments *

I understand the estimated cost for the service requested on behalf of the participant. I consent to Ability Action Australia commencing services up to the limit provided. If there is any change to this estimated cost, Ability Action Australia will provide a written Service Funding Approval document for review and approval from relevant parties.

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Let’s get started

Full referral form

Participant details

Partial referral form

Participant details

Disability background

Services required

Consent & payments

Who we help

Our services

About us

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Ability Action Australia is a registered NDIS provider