Prelude Australia Referral Form

At Prelude Australia, we’re here to support a positive future for all children.

Trusted by our community for over 40 years, we deliver connected, capacity-building early childhood & therapy supports for kids birth to twelve.

We are focused on meaningful outcomes for children that support participation and independence in their everyday lives.

It’s about real people, in real places, doing real things.

Child's Details

First Name *

Last Name *

Date of Birth *Prelude Australia only support children birth to twelve years old.

Street address *

Suburb *

State *

Postcode *

Gender *

FemaleMaleNon-binaryOther

Does the child have a disability? *

YesNoUnsure

Please list disabilities below

Does the child attend daycare, preschool or primary school? *

YesNo

What daycare, preschool or primary school do they attend? *

Is there any documentation regarding court/ guardianship arrangement-? *

YesNo

Funding

I would like to pay using a *

NDIS PlanMedicare- care planFee-for-serviceUnsure

Child's NDIS number *

Child's NDIS plan dates *

How is the NDIS funding managed? *

AgencyPlanSelf

The management of funding will be stated within the NDIS plan under: Capacity Building Supports- Improved Daily Living Skills budget

GP practice *

Medicare number *

Child's primary contact

First name *

Last name *

Phone Number *

Email address *

Relationship to child *

Referrer Details (if different from above)

First name

Last name

Agency

Role

Email Address

Phone number

Reason For Referral

Which waitlists would you like to join? *

NDIS Early Childhood TeacherOccupational TherapyPhysiotherapySpeech Therapy

For young children we encourage families to work with NDIS Early Childhood Teachers as their Key Worker who can help to coordinate Allied Health services.

Our NDIS Early Childhood Teachers have experience in supporting children from birth to 9 years old. We work closely with families to support children at home, preschool/ primary school and in the community-(shopping centres, park, playgroup) in the following areas but not limited to:

Support of learning, language, social skills, and daily living skills within everyday routines
Emotional regulation and expressing feelings
Participating in both community and educational settings
School readiness skills
Transition to preschool or kindergarten

As NDIS Early Childhood Teachers, they understand all areas of child development while looking at the whole child and can be the eyes to see the child’s needs, interests and strengths.

Other concerns

Does your child have any choking or swallowing concerns?

YesNo

Is your child experiencing reduced hours, reduced days or have been denied access to an education setting based on their support needs?

YesNo

Anything else you would like to share?

Once the referral form has been submitted our administration team will receive the request and add the child to the requested waitlists.

We do not have definitive wait times for our services. As Prelude Australia staff only support children to the age of 12 and NDIS funding changes our staffs capacity changes to reflect the current support requirements. When staff have capacity to support your child administration will be in contact with the primary carer to offer support and discuss booking an intake meeting.

Thank you

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