Make a Referral - Afterlight Support

Important: Please ensure you have the participant's (or their guardian's) consent before submitting this referral. We will contact the participant directly to discuss our services.

Participant Details

First Name *

Middle Name(s)

Surname *

NDIS Number *

Date of Birth *

Primary Diagnosis (optional)

NDIS Plan Details

Plan Start Date *

Plan End Date *

Plan Management Type *

Plan Manager Details (if Plan Managed)

Complete this section if the participant's plan is plan managed.

Plan Manager Name / Organisation

Plan Manager Email (for invoices)

Plan Manager Phone

Referral / Contact Person Details

Person completing this form.

First Name *

Surname *

Relationship to Participant *

Phone Number *

Email Address *

Participant Contact Details

Phone Number *

Email Address *

Preferred Method of Contact *

Additional Contacts (if applicable)

Name

Relationship

Phone

Consent

I confirm I have consent to share this information and to engage support coordination services. *

Name *

Date *

What happens next: We'll contact the participant within 2 business days to introduce ourselves and discuss how we can help. We'll also keep you informed of the outcome (with the participant's consent).

Questions About Referring?

If you have questions about the referral process or want to discuss a participant's needs before referring, please contact us:

Phone: 0420 744 771
Email: referrals@afterlightsupport.com.au

Urgent Referrals

For urgent referrals (e.g., participant at risk, hospital discharge, crisis situation), please call us directly rather than using this form.

Phone: 0420 744 771

Professional Referral

Questions About Referring?

Urgent Referrals