Communication Preferences

Your Goals

In addition to your goals listed in your NDIS plan, what are your goals for your time with HDS?

Risk Assessment

This section requires you to disclose any significant risks that may relate to your supports requested.

Please list any risks identified, relevant to your supports

Risk severity

If you are receiving supports under 0107 - Daily Activities, please tick all that apply below:
Receive supports in your homeDo not regularly receive face-to-face supports from other NDIS providersHave limited regular contactwith relatives, friendsor a support networkDepend on equipment or another person to assist with their physical mobilityDepend on anotherperson to assistwith communicationDepend on equipmentto facilitate communication or the use of communication devices

Your Decision Making - Informal

This section asks about your advocate, family member, friend etc. (NOT Formal Guardian)

Do you receive any help with your decision making?
YesNO - go to the next page

If Yes, what are their details?

First Name

Last Name

Phone Number

Relationship with you

Guardianship Functions

This section asks about details of any formal guardianship orders you have in place

Do you have a Formal Guardian
YesNO - go to the next page

If Yes, what are their details?

First Name

Last Name

Phone Number

Financial Management

This section asks about details of any formal financial management you have in place

Is there anyone that provides your financial management ie. TAG?
YesNO - go to the next page

If Yes, what are their details?

First Name

Last Name

Phone Number

NDIS - Coordination of Supports

If you have a current Coordinator of Supports, please record their details below

Name

First Name

Last Name

Phone Number

Completing this form

Did you require assistance completing this form?

If so, please record the details of the person whom completed it.

Name

First Name

Last Name

Phone Number

Role of this person