Referral for Services

To enquire about receiving services from Disability Connect Victoria, please complete the below form and a member of our Client Relations team will reach out to you.

Are you enquiring on behalf of yourself or someone else?

Myself

Someone Else

Support Information

Support Required

Are there any high intensity supports required?

Yes

No

I'm not sure

Is support required with managing behaviours of concern?

Yes

No

I'm not sure

Is support with medication required?

Yes

No

I'm not sure

Is support required to help manage a medical / health condition?

Yes

No

I'm not sure

Desired Start Date of Services

Support Frequency

Weekly

Fortnightly

Monthly

Ad-Hoc / Random

Information about specific support requirements from DCV support workers

Would you like an in-person or digital intake meeting?

Digital

In Person

OPTIONAL; Please upload any relevant care plans or documentation that will help us assess your enquiry.

Add up to 10 files

Any documentation uploaded via this form is stored securely on Australian Servers. Should you not proceed with services from DCV, your information is deleted from all DCV systems within 30 days of your enquiry closing.

Uploading documentation is optional, and simply helps us to quickly assess your enquiry.

If you are uploading documents on behalf of someone else, please ensure you have consent to share this information with DCV prior to uploading it.

Next Steps

Based on your preferred method of meeting, a member of our Client Relations team will be in contact in-person or digitally to plan how DCV will provide the support you have requested and explain what documents DCV will need you to provide to ensure we can provide safe and high-quality support.

We will reach out within 1 business day to start planning this process, and to let you know how soon we can provide supports to you.

If your request is urgent and you require support to commence within the next 7 days, please call DCV on 03 9052 4470 to discuss priority commencement. If DCV are unable to commence on your desired timeframe, we can assist in referring you on to another quality provider.