Request for Service - Unique Needs

Request for Service

Please fill in this form to request support services from Unique Needs.

Participant Information
Referral Details, Support Coordinator & Billing

Referrer & Consent

Support Coordinator Contact

NDIS & Billing

Availability – Exact Shift Times

Add each required shift: choose day, start & end times, and notes.

Supports Requested — Line Items

Add the support items (e.g., Support Work, Cleaning), NDIS line item or description, the quantity/frequency, and any notes.

Reason for Referral
Upload NDIS Plan, OT Reports and any other relevant documents

You may attach PDFs or Word documents (max 5MB each).