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NDIS funded participant details

First name *

Last Name *

Preferred name

NDIS Number *

NDIS Plan Start Date *

Date of birth *

Authorised Nominee (if applicable)

Street Address *

Suburb *

State *

Postcode *

Contact Email *

Phone

Preferred Contact Method

How would you like your invoices to be approved? * How would you like your invoices to be approved?

Would you like to use our Easy-Care app or website to be able to view or approve your invoices?

Yes (applies to App and/or Website login)

No (you can change your mind at any time)

Upload your NDIS Plan

Maximum file size: 12MB

Upload other documents

Maximum file size: 12MB

Person who completed the form:

Participant

Nominee / Representative

Support Coordinator / Other (please provide your details)Support Coordinator / Other (please provide your details)

For Support Coordinators completing on behalf of a client:
We will need to contact the client to ensure we have their permission to proceed as their plan manager.

Are you transferring from another Plan Manager?

Yes

What date did you give notice to your previous Plan Manager?

How did you hear about us? How did you hear about us?

Any Other Information

*By clicking submit, you agree to the terms and conditions of our service agreement. We will also send you a blank copy via email.

Service Agreement

I have read and agree to the terms and conditions of the current Service Agreement.

If you are human, leave this field blank.

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NDIS funded participant details

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