Make a Referral

At Jewel Australia Support Services, we welcome referrals for individuals seeking reliable, person-centred NDIS support. This referral form allows participants, families, support coordinators, and other stakeholders to refer someone who may benefit from our services. All referrals are reviewed promptly, and our team will make contact to discuss support needs, goals, and next steps. Information provided through this form is treated confidentially and in line with privacy and NDIS requirements. Please complete the form below, and a member of our team will be in touch.

Participant Full Name
DD-MM-YYYY
Checkboxes
Aboriginal or Torres Strait Islander
NDIS Plan Status
DD-MM-YYYY
DD-MM-YYYY
Early Review Requested
Support Level
Funding Management
Full Name
Full Name
Service Categories Requeste
Behavioural Support Needs
Communication Needs
Manual Handling Requirements
Type of Staff Required
Gender Preference
Experience Required
Staff Ratio Required
DD-MM-YYYY
Public Holiday Support
Community Acces & Transport
Invoice Contact Name
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