Make a Referral

Refer yourself or someone you support

You can refer yourself or someone you support. Share a few details so our team can discuss the next steps.

Fields marked * are required. You don’t need an NDIS number, diagnosis or documents to start.

About you

Your name

Relationship to the participant

For example: myself, parent, support coordinator, hospital social worker.

Organisation, if relevant (optional)

Contact phone (optional)

Phone or email — at least one.

Contact email (optional)

About the participant

Participant name

Participant suburb

Support being requested

Preferred contact method

Language or communication preferences (optional)

For example: interpreter needed, prefers text messages, AUSLAN.

Anything else you’d like us to know? (optional)

Keep it short—we’ll talk through the details with you.

I am the participant, or I have the participant’s consent or appropriate authority to make this referral.

I have read how CCM handles personal information in the Privacy page.