Eligibility – iCare Ability

Skip to content

Home
About Us
Services
NDIS Referral Form

Home
About Us
Services
NDIS Referral Form

Call Us On

Edit Content

Menu

Home
About Us
Services
NDIS Referral Form

Call Us On

1300 356 643

Home
/
Eligibility

Eligibility

Forms

NDIS Referral Form
Feedback
Careers
Check Eligibility

Contact Details

Call Us

Email Us

info@icareability.com.au

Please enable JavaScript in your browser to complete this form.

Please complete this form to determine your eligibility for receiving services from iCare Ability. Your responses will remain confidential and will be used solely for assessing your eligibility.

Personal Information:

First Name *

Last Name *

Date of Birth *

Gender *

Male
Female
Others

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone Number *

How Did You Hear About Us? *

Email Address *

1. Are you impacted by any disability? *

Yes
No

Please indicate whether you have a disability that impacts your daily life and requires support.

If yes, please provide a brief description of your disability *

2. NDIS Participant Status: *

I am already an NDIS participant.
I have applied for the NDIS.
I am not an NDIS participant and have not applied.

Are you currently an NDIS participant or have you applied for the NDIS?

3. NDIS Number (if applicable):

Please provide your NDIS number if you are already an NDIS participant.

4. Support Category: *

Accommodation/ Tenancy (0101)
Assist Life Stage Transition (0106)
Assist Personal Activities (0107)
Assist Travel/Transport (0108)
Home Modification (0111)
Daily Tasks/Shared Living (0115)
Innov Community Participation (0116)
Life Skills Development (0117)
Household Tasks (0120)
Participate Community (0125)
Specialised Disability Accommodation (0131)
Group/Centre Activities (0136)
Other (Specify)

Please indicate the main category of support you are seeking from iCare Ability.

Single Line Text *

5. Funding Plan: *

Yes
No

Do you have an NDIS funding plan in place?

If yes, please provide the details of your funding plan:

6. Goals and Needs: *

Briefly describe your main goals and the specific support needs you are looking for.

7. Medical and Health Information: *

Please provide any relevant medical or health information that may impact the services you require.

8. Additional Information: *

Is there any additional information you would like to share about your situation or needs?

9. Permission to Contact NDIS: *

Yes
No

Do you grant us permission to contact the NDIS on your behalf to verify your eligibility and funding status?

10. Are you of Aboriginal and/or Torres Strait Islander origin? *

Yes
No

11. Preferred Contact Method: *

Phone
Email

How would you prefer to be contacted regarding your eligibility assessment?

12. Consent to Data Collection: *

I consent

By submitting this form, you consent to the collection and use of your personal information for the purpose of assessing your eligibility and providing relevant services.

Attachments

Click or drag files to this area to upload. You can upload up to 5 files.

13. Signature: *

Please write your name to confirm your submission.

Thank you for completing the eligibility form.

Our team will review your information and contact you shortly to discuss your eligibility and next steps.

For any immediate questions, please contact our customer support at info@icareability.com.au

We’re Here to Support You

Looking for care or guidance? Fill out the contact form, and we’ll get back to you shortly.

Contact Details

Call Us

Email Us

info@icareability.com.au

Please enable JavaScript in your browser to complete this form.

Full Name *

Mobile Number

Email Address *

Services

Message

Contact Details

1300 356 643
info@icareability.com.au
Suite 3, 102 South Street, Granville, NSW 2142

Quick Links

Home
About Us
Contact Us
Referral
Feedback
Careers
Check Eligibility

Home
About Us
Contact Us
Referral
Feedback
Careers
Check Eligibility

Services

Accommodation/ Tenancy (0101)
Assist Life Stage Transition (0106)
Assist Personal Activities (0107)
Assist Travel/Transport (0108)
Home Modification (0111)
Daily Tasks/Shared Living (0115)
Innov Community Participation (0116)
Life Skills Development (0117)
Household Tasks (0120)
Participate Community (0125)
Specialised Disability Accommodation (0131)
Group/Centre Activities (0136)

Accommodation/ Tenancy (0101)
Assist Life Stage Transition (0106)
Assist Personal Activities (0107)
Assist Travel/Transport (0108)
Home Modification (0111)
Daily Tasks/Shared Living (0115)
Innov Community Participation (0116)
Life Skills Development (0117)
Household Tasks (0120)
Participate Community (0125)
Specialised Disability Accommodation (0131)
Group/Centre Activities (0136)

Stay Informed

Enter your email below to sign up for our e-newsletter

Leave this field empty if you're human:

Copyright © 2025 All rights reserved to iCare Ability. Designed by Searchbar

Scroll to Top