Core Assist NDIS Eligibility Qualification Assistance Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastAre you under 65 years of age?YesNoEmail *Phone *Location/SuburbDo you have a disability or diagnosis? *YesNoPlease select your disability or diagnosis from the listBehavioural or emotionalSensory impaired disordersPhysicalDevelopmentalPlease enter the disability or diagnosis below:Can you provide evidence of your disability? *YesNoTick the documentation you can provideMedical History Records - Provided by your GPSpecialist Medical Records/ReportsPsychologist Reports - including IQ testingTreating Health Professional (Occupational Therapist, Physiotherapist, Speech Therapist etc)Please upload relevant documentation regarding your diagnosis: Click or drag a file to this area to upload. Upload more documentation if neccessary: Click or drag a file to this area to upload. Preferred Contact Method? *PhoneEmailAdditional Comments or QuestionsSubmit go back
