Disability Support Services

Capacity Form

Referral / Capacity form

Find a carer to match your needs & likes.

Ranging from personal care, home care and community participation.

Any question, please call us on 03 8618 6920 (Melbourne) and 08 8113 5345 (Adelaide)

Capacity Form

This brief referral/capacity form will help us get a better understanding of your needs and be able to give us enough information to provide to suitable support workers. With this form we will be able to let you know if we have the capacity. Once step 1 is complete, we will send you an
intake form and guide you on next steps.

Step 1
Step 2
Step 3
Step 4
Step 5

Information

Person Completing Form

Role of Person Completing Form

Email of Person Completing Form

Contact No of Person Completing Form

Participant Name

Participant Gender

Male Female Other

Preferred Pronouns

Funding

Note

Type of disability

Date of birth

Country of origin

Staff gender preference

Shift location (suburb only)

Preferred language of staff

Living arrangements

Note

Transport Arrangements

Note

Participant approved for transport No Yes

Public holidays approved No Yes

NDIS Goals

NDIS Budget allocated to Sendayo Supports ($ figure)

Weekly schedule

Shift Description/Requirements

Hobbies and outings suitable to the participant

Ideal start date

Does the participant have an animal?

Brief client description

Any behaviours of concern?

Risk Questionnaire

What is the level of risk involved in regard to: Manual handling tasks? (e.g. personal care, lifting, supporting or transferring clients, etc)