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.

Your Details (Referrer)

Your Name *

Your Role *

Organisation (Optional)

Your Email *

Your Phone *

Participant Details

Please provide basic information about the participant. We'll contact them directly for full details.

Participant Name * For privacy, you can use first name or initials only

Suburb/Region *

Age Range *

Support Needs and NDIS Information

Primary Support Needs *

The participant is an active NDIS participant

Support Coordination is funded in their current NDIS plan

If you're unsure, that's okay - we can check with the participant

Consent Confirmation

I confirm that the participant (or their guardian/decision maker) has consented to this referral and to Afterlight Support contacting them. *

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