Intake
Fill in our intake form and we will contact you to begin planning your supportIntake Process
- Complete the application form
- Intake Team will contact the referrer to discuss the application
- Management reviews all applications every Thursday
- Intake Team will contact the referrer in relation to the outcome
- If approved: Meet & Greet will be organised for the Service Agreement to be signed
- Services will then commence
Please note: This process may take up to 2 weeks to be completed and support shifts are offered for a minimum of 3 hours.
Application for Direct Support
We have revised our application process to be more streamlined to eliminate unnecessary wait times for participant intake. This application form will take approximately 10 to 20 minutes to complete. If you require support in completing this form, please contact our Intake Team on 03 8407 0940.
Application for Direct Support
We have revised our application process to be more streamlined to eliminate unnecessary wait times for participant intake. This application form will take approximately 10 to 20 minutes to complete. If you require support in completing this form, please contact our Intake Team on 0405 844 761 or 03 8407 0940.
Application for Direct Support
We have revised our application process to be more streamlined to eliminate unnecessary wait times for participant intake. This application form will take approximately 10 to 20 minutes to complete. If you require support in completing this form, please contact our Intake Team on 0405 844 761 or 03 8407 0940.
Application for Direct Support
We have revised our application process to be more streamlined to eliminate unnecessary wait times for participant intake. This application form will take approximately 10 to 20 minutes to complete. If you require support in completing this form, please contact our Intake Team on 0405 844 761 or 03 8407 0940.
Application for Direct Support
We have revised our application process to be more streamlined to eliminate unnecessary wait times for participant intake. This application form will take approximately 10 to 20 minutes to complete. If you require support in completing this form, please contact our Intake Team on 0405 844 761 or 03 8407 0940.
Referrer Details
Does the participant give you consent to complete this form that includes their personal information?
How did you hear about Including You?
Participant Details
Which of the following most accurately describe(s) you?
Do you reside by yourself?
Preferred methods of contact
Do you have a Guardian or Advocate?
Emergency Contact
Parent/Guardian 1 (If applicable)
Additional relationship options
Parent/Guardian 2 (If applicable)
Additional Relationship Options
NDIS Plan Information
Do you have a Companion Card?
Funding Allocation
Direct Support Invoicing Arrangement
Transport Invoicing Arrangements
Funding available for training of appropriate support strategies to assist with
Service Providers Currently In Use
Is the participant or a member of their family involved in Child Protection?
Are any family services involved with the participant or their family?
About You
Background Information
Is an interpreter required?
Do you identify as Aboriginal?
Do you identify as Torres Strait Islander?
If yes, would you like Including You to provide you with a list of ACCOs that provide similar services so you may choose to access these if appropriate?
Do you identify as part of the LGBTQIA+ community?
Do you have a documented profile?
Behaviours of Concern
Are there Behaviours of Concern present?
If yes, please list relevant behaviours (This helps ensure that we are appropriately supporting the participant)
Do you have a Behavioural Support Plan (BSP)?
Personal Care
Are there any Personal Care requirements you need support with? E.g., toileting, bowel management, dressing, showering
Do you have difficulty swallowing? e.g., Dysphagia
Do you have a Care Plan?
Physical Assistance
Is physical assistance required? e.g., Transferring, use of hoist, wheelchair assistance
Do you have any communication aids? e.g., National Relay Service, pictures, symbols, hearing aid
Do you require any support during mealtimes? E.g., preparation with meals, support with eating, peg feeding, drinking
Medical Information
Are you taking any medication that comes under Chemical Restraint/Restrictive Practice?
Is assistance with medication required on shift?
Do you have a specific Health Care Plan to assist us to manage this?
Shift Preferences
Do you also require Support Coordination through Including You?
Direct Support Worker Preferences
What days are you interested in receiving support? (Please note: Support shifts are provided for minimum of 3 hours)
What is your preferred frequency for support?
Activities
Activities/ tasks you would like assistance with for your support worker
Will supports occur within your home?
Is there any other information you would like Including You to know about you?
I declare that to the best of my knowledge, the information provided in this application is true, correct, and accurate.
Non-Discrimination Policy
Including You believes in an inclusive service. This means we are committed to being an inclusive and respectful service that welcomes all. Sex, gender ,identity, sexual orientation, age and religion.
