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Service Enquiry

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Our service enquiry system has been thoughtfully developed to ensure individuals can easily access the care and support they need. Whether you are a healthcare professional or a caregiver, your enquiry helps us reach those who may benefit from our specialised services.

 

We are currently accepting enquiries in:

  • Shepparton

 

By working together, we can make a genuine and lasting difference in the lives of those we support.

Service Enquiry

IMPORTANT

** Please note, This is an enquiry form only. Focus will respond to your enquiry and advise you of the next steps for Intake.

If you have not received a reply within 24 hours, please check your junk or spam folder, or email admin@focusbehaviour.com.au


Before you commence this form, please ensure you have the following necessary details ready.


1) NDIS number

2) Plan Start and End dates

3) A copy of the allocated or remaining funding amounts

ABOUT THE PARTICIPANT

Gender
Date of birth
Day
Month
Year
Type of Residence
Family Home
Supported Independent Living
Foster Care
Prison
Independent Housing
Other
Fund Management Type

Plan Nominee (authority to approve documentation)

Check all behaviours that have occured in the last 6 months

Total Behaviour Support Funds budget (balance remaining at time of referral)

You can add up to 2 files - maximum limit of 10mb

How urgent do you rate this enquiry?

How urgent do you rate this enquiry?
Low
Medium
High

LOW

Mild verbal abuse without the use of foul language

Physical aggression towards an object that requires clean-up


MEDIUM

Physical contact not requiring medical attention

Verbal abuse, including foul language

Physical aggression towards objects that cause some damage to the objects


HIGH

Physical contact requiring first aid

Verbal abuse, including threats of violence

Physical aggression towards an object that requires replacement of things (dependent on the object)

ENQUIRERS DETAILS

Consent (Do you have consent from the participant/Guardian to make this enquiry?)
Yes
No
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