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Preparing for the Next Stage:

salamshub@gmail.com / September 10, 2024

Transitioning to a new stage, whether it’s starting school, moving to a new class, or another significant change, can be […]

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Hello world!

salamshub@gmail.com / September 8, 2024

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Services

Allied Health
Early Childhood Intervention support
Functional Capacity Assessments
Specialist Behaviour Support
Rehabilitation Counseling
Occupational Therapy
Psychology

Address info

hello@salamstherapyhub.com
1800 SALAMS

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Welcome to Ability Action Australia! To request our services, just fill out the referral form below—it’s that easy. If you run into any issues, you can click the Call Back button for help. For a direct conversation, our Concierge team is available at '098765456789' or via email at 'admininfo@gmail.com'.com.au. Let’s get started!

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How would you/participant prefer to receive our services?

TelehealthFace to faceEither

Which services are you/participant interested in?

Occupational TherapyPhysiotherapyExercise PhysiolohySpeech PhysiologyI am unsure

PhysiologyPositive Behaviour SupportSchool Leave Employment SupportEmployment-related Assessment and CounsellingKey Worker

Do you have an approved NDIS plan or are you awaiting approvalI have an approved planI am awaiting approval

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Who is the Plan Nominee or Child Representative?MeOther

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I am a Participant
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Client Details

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First Name *

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Client Email Address *

Street Address *

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City *

State *

Postcode *

Client Representative Details (Parent/Guardian/Support Coordinator/LAC)

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First Name

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Organisation Name

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Phone Number

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City

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NDIS Details

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Plan Manager Agency (If Applicable)

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Available/Remaing Funding for Capacity Building Supports

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Client Goals (As stated in the NDIS plan)

DISABILITY AND HEALTH INFORMATION

Primary and/or Secondary Disability *

Are there any disability or health related risk factors that our staff need to be made aware of? *

High falls risk
Unaddressed incontinence
Absence of hygiene supports
Not yet engaged with support services (e.g. no support workers)
PPE required when visiting?
Other (any other potential risk factors, please describe below under "Are there any issues our visiting staff should be aware of?")

Please tick the services required *

Early Childhood Intervention Support (0-9 Yrs)
Specialist Behaviour Support
Rehabilitation Counselling
Functional Capacity Assessment
Occupational Therapy
Support Coordination
Psychology

Consultation Preference *

Home visits
Telehealth (online)

Total Support Hours Requested *

For ongoing therapy services, please select your preferred frequency *

Home Risk Assessment

Do you consent to home visits? *

What type of dwelling do you live in? (house, flat, unit, facility, caravan park, other) *

Are there any issues our visiting staff should be aware of? *

Do you have room inside your home for visiting staff to conduct the meeting/appointment? *

How many people live at your house? *

Do you, or anyone that may be present, have a history of concerning behaviours, drug and/or alcohol issues, or physical/verbal violence and aggression towards others? *

Do you have any weapons or firearms at home? *

Do you, or anyone that may be present, have any infectious diseases? *

Are there any animals on your property? If yes, what are they? *

Are there any concerns with neighbouring properties?

Do you have phone/internet reception in your home? *

How did you hear about us?

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Preparing for the Next Stage:

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