Referral – Rotana Care

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Send Your Referral Online

Name of Referrer

Referrer’s Agency

Email

Phone Number

Address

Name

Date of Birth

Phone

Email

Address

Marital Status

Single Married Widowed Divorced

Does the participant have an active NDIS plan?

Yes No

Provide NDIS number if you answer ‘Yes’ above

Upload NDIS Plan

Participant Identifies as

Country of Birth

Language Spoken at Home

Does the client have a disability?

Yes No

Provide details if you answer ‘Yes’ above

Reason for referral

ParticipantShort-term and Long-term Goals

Participant Required Supports

Participant Preferred Support Worker Gender/Identity

Male Female Non-binary Transgender

Participant Skills and Strengths

Or Download Our Referral Form

At Rotana Health & Wellbeing, we make the referral process simple and hassle-free. Click the link below to download our referral form, fill it out with the required details, and email it back to us at [email protected]. Our team will review your submission and get in touch to discuss the next steps. If you need any assistance, feel free to contact us—we’re here to help!

Location

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