NDIS Service Request | Skylight Info

Are you submitting this form for yourself or on behalf of another?

Myself

On behalf of another

Submitter Name *

First

Last Name *

Last

Relationship with the Client

Are you a NDIS Nominee and/or Legal Guardian for the participant?

Yes

No

Please provide a copy of the participant's current Guardianship order or confirmation as Plan Nominee in the file dropdown at the bottom of this page.

Participant's Name *

First

Last Name *

Last

What is the participant's NDIS Number?

What is the participant's date of birth?

What is the participant's phone number? (inclusive of area code if applicable)

What NDIS services is the participant interested in accessing?

Plan Management

Support Coordination

Specialist Support Coordination

Psychosocial Recovery Coach

Individual Support

Activity Groups

Therapeutic Groups

Counselling

One-to-One Art Therapy

Please note, there is no current capacity for new participants outside of the metro area for Support Coordination, Specialist Support Coordination, or Psychosocial Recovery Coach participants.
Spots are limited in the Metro area.

Is the participant a current NDIS participant with Skylight Mental Health?

Yes

No

What is the participant's email address? *

Enter Email

Confirm What is the participant's email address? *

Confirm Email

What the participant's gender? What the participant's gender?

What is the participant's primary disability? What is the participant's primary disability?

Participant's Street

Participant's Suburb

Participant's State

Participant's Postal Code

What region does the participant reside in?

How did you hear about us? How did you hear about us?

What is the participant's NDIS plan start date?

What is the participant's NDIS plan end date?

What is the participant's preferred communication method?

Phone

Email

Mail

Do you wish to opt in to receive Skylight news and product information via email or SMS?

Yes

No

Is the participant currently under a guardianship or supervision order?

Yes

No

Please provide us a copy of the participant's guardian or supervision order in the below file upload section.

Does the participant have a NDIS Plan Manager?

Yes

No

I have funding for a Plan Manager but have not selected one yet

Who is the participant's current Plan Manager?

What is the participant's Plan Manager's email address?

Does the participant have a NDIS Support Coordinator and/or Psychosocial Recovery Coach?

Yes

No

I have funding for a SC / PRC but have not selected one yet

Who is the participant's current Support Coordinator?

What is the participant's Support Coordinator's email address?

Does the participant have a Carer?

Yes

No

Carer's name

Carer's Phone Number

Carer's Email

Does the participant have an Emergency Contact?

Yes

No

In the event the participant does not have an Emergency Contact, we will notify Mental Health Triage 13 14 65 if we have serious concerns about their wellbeing.

Who is the participant's preferred Emergency Contact?

Emergency Contact Phone Number

Emergency Contact Email

Please provide a copy of the participant's current NDIS plan and/or any other relevant files

Maximum file size: 2.1MB

Essential Forms for Your Skylight Journey

Service Request Form

NDIS Service Request Form

Please provide a copy of the participant's current Guardianship order or confirmation as Plan Nominee in the file dropdown at the bottom of this page.

Please note, there is no current capacity for new participants outside of the metro area for Support Coordination, Specialist Support Coordination, or Psychosocial Recovery Coach participants.
Spots are limited in the Metro area.

Please provide us a copy of the participant's guardian or supervision order in the below file upload section.

In the event the participant does not have an Emergency Contact, we will notify Mental Health Triage 13 14 65 if we have serious concerns about their wellbeing.

Essential Forms for Your Skylight Journey

Service Request Form

NDIS Service Request Form

Please provide a copy of the participant's current Guardianship order or confirmation as Plan Nominee in the file dropdown at the bottom of this page.

Please note, there is no current capacity for new participants outside of the metro area for Support Coordination, Specialist Support Coordination, or Psychosocial Recovery Coach participants. Spots are limited in the Metro area.

Please provide us a copy of the participant's guardian or supervision order in the below file upload section.

In the event the participant does not have an Emergency Contact, we will notify Mental Health Triage 13 14 65 if we have serious concerns about their wellbeing.

Please note, there is no current capacity for new participants outside of the metro area for Support Coordination, Specialist Support Coordination, or Psychosocial Recovery Coach participants.
Spots are limited in the Metro area.