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Expression of Interest
WELCOME TO OUR VOICE OUR CHOICE
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Step
1
of 9
How can we help?
I am looking for support for myself
I am looking for support for a friend or family member
Other / I would rather not say
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Name
*
Email
*
Phone Number
*
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Next
Name
*
Date of Birth
*
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Next
Gender
*
Male
Female
Rather not say
Does the person requiring support identify as being of Aboriginal or Torres Strait Islander origin?
*
Yes
No
Rather not say
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Next
Address
*
Address Line 1
City
State / Province / Region
Postal Code
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Next
Please let us know which of the below to apply to the person requiring support
*
Intellectual Disability
Physical Disability
Neurological Disability
Mental Health Disability
Other
Please briefly describe the nature of the disability
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Next
NDIS
status of person requiring support
*
There is an existing
NDIS
plan
NDIS
plan in progress
NDIS
eligible
Unsure of
NDIS
status
I would like to enquire about the following
OVOC
services
*
Supported Independent Living
Community Supports
Short Term Accommodation/Respite
Support Coordination
Other
Do you already have an
NDIS
funding package?
Yes, for Supported Independent Living
Yes, for Community Supports
Yes, for Short Term Accommodation/Respite
Yes, for Support Coordination
Yes, for Other
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Next
Please provide some detail on the services you are seeking
Please add any other details you may think we need to know
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Where did you hear about
OVOC
?
Referral/Word of Mouth
Online Search
NDIA
I accept Privacy and Consent
By completing this form, I consent to Our Voice Our Choice collecting and exchanging personal information about the Person Requiring Support with relevant third parties, for the purpose of assessing eligibility for services offered by Our Voice Our Choice. I confirm that I have authority to provide this consent. I understand that the collection of information for this referral in voluntary, and that Our Voice Our Choice is bound by Federal Privacy Legislation.
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