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Participant DOB
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Phone Number
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NDIS Number
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NDIS Plan Dates
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Emergency Contact Details (Name and Phone)
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Support Coordinator (Name and Contact - if applicable)
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Plan/ Self Management Details (Organisation and Email)
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About You - Likes and Dislikes
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Do you have any behaviours of interest? If yes, what are they and how can we best support you to navigate them?
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What is your diagnosis?
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Are you able to respond in an emergency situation? Do you require support with this? (i.e. prompts, physical support etc)
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Do you have any cultural needs you would like us to be aware of?
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Are you on any medications?
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Do you have any dietary requirements?
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What foods do you like? (particularly, if you are looking into respite, please provide a detailed list of meal/ snack choices)
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What foods, if any, do you dislike?
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Do you have any sensory requirements/ preferences?
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What are your NDIS goals? (or if you would prefer to email your plan, simply write "as per email" and email this information to info@apexxsupport.com.au)
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Is there any additional information you would like us to know?
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Apexx requests that you send any relevant documentation, such as OT, Speech or Behaviour reports prior to service commencing to info@apexxsupport.com.au. If you have any questions, please phone us on 0493 286 194
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