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?*
    What capacity are you referring in?

    Your Information

    Your First Name*
    Your Last Name
    Phone Number*
    Email Address*
    Relationship to Client*

    Client Information

    First Name*
    Last Name*
    Preferred Contact Method*
    Number Field*
    Email Address*
    What region do you live in?*
    Town / City*

    Upon submission of this form, our intake team will reach out to discuss commencement timeframes with you to ensure suitable before proceeding.

    DCV are currently accepting waitlist applications for South Gippsland.

    If you would like to be added to our waitlist and contacted when capacity is available, please continue with this form.

    DCV are currently accepting waitlist applications for East Gippsland.

    If you would like to be added to our waitlist and contacted when capacity is available, please continue with this form.

    Upon submission of this form, our intake team will reach out to discuss commencement timeframes with you to ensure suitable before proceeding.

    Upon submission of this form, DCV will reach out to you to discuss commencement timeframes upon confirmation of your region.

    Support Information

    Support Required*
    What Accommodation Support is required?*
    Are there any high intensity supports required?*
    Which High Intensity support is required?*
    For any high intensity support, client specific training is required from a qualified health professional.*
    DCV will be unable to commence support until this training is provided, we will work with you to organise this training as soon as practical.
    High Intensity supports are those that require higher skilled Disability Support Workers, this includes:
    • Complex Bowel Care
    • Enteral Feeding Support
    • Dysphagia Support
    • Ventilator Support
    • Tracheostomy Support
    • Urinary Catheter Support (In-dwelling Urinary Catheter, In-out Catheter, Suprapubic Catheter)
    • Subcutaneous Injections
    • Complex Wound Care Support
    Is support required with managing behaviours of concern?*
    This includes any support to somebody with known behaviours, whether or not there is an interim or comprehensive behaviour support plan in place.
    Is support with medication required?*
    This support can be anything from prompting to administering of medication.

    Please note; when supporting clients with medication (including administration or prompting) DCV require documentation in place to ensure the safe administration of this medication.

    During the intake process we will ask you for documentation, including treatment sheets and medication purpose forms in order to create this documentation and support you safely.

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

    Please note; depending on applicable medical and/or health condition(s), we may require additional information to ensure we are supporting you correctly.

    This varies depending on the medical and/or health condition(s) and how you wish DCV to support you. Our Client Relations team will discuss this with you further upon receipt of your enquiry.

    Desired Start Date of Services*

    Please note; DCV will work with you to try and meet your desired start date of services, however various factors will determine how quickly services can commence.

    This includes;

    • Our ability to get in touch with you or your representative to gather information needed to safely provide supports.
    • The provision of documentation and support plans necessary to provide supports (For example; behaviour support plans, medication related documentation, bespoke and other support plans - based on your support requirements).
    • Our capacity in your area and whether any targeted recruitment is required.
    • Engagement with other health professionals in your care team (if applicable) for any specific training required for our support workers to provide support.
    Support Frequency*
    Days Support Required*
    Information about specific support requirements from DCV support workers
    Use the space above to let us know about any important aspects of your support. This helps us to understand what support you require, and whether DCV can help you.
    Would you like an in-person or digital intake meeting?*

    Please note; in person intake meetings will be arranged within 7 days of referral receipt based on your availability.

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