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Send Us a Message

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Enter your full name
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Enter your personal email address
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Enter your contact phone number
Choose an interest that suits you
Ask a question or leave a message
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Congratulations! Your message has been received. We will be in contact shortly to discuss your enquiry.
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Professional Referral Form

Start by adding the client's personal information.

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NEXT: Select tab 2 to add funding details.
Now enter your client's funding details.

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NEXT: Click tab 3 to add support details.
Complete the details for invoicing and support coordination.

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Contact Details for Invoice

If Plan Managed or Self-Managed

Support Coordinator or LAC

Add contact details of the Support Coordinator or LAC.
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NEXT: Click tab 4 to add your client's support goals.
Finally, please share your client's support goals with us.
NOW: Double check the information and submit your referral.
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Success!

Thank you! Your referral has been received. We will be in contact with the client shortly to discuss their needs.
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Professional Referral
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Use this form to refer your client to Connecting Futures

This form is intended to help NDIS and medical professionals to put their clients in contact with Connecting Futures.

If you have a general enquiry please use the form at the top of this page, or if you have feedback or a complaint you can use the form at the bottom of this page.

Feedback
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Use this form to provide feedback or complaint to Connecting Futures

Provide us with feedback or a complaint using this form. Your feedback can be good or bad. We want to hear about your experience with Connecting Futures.

If you have a general enquiry please use the form at the top of this page.

If you have any questions about this form or require support to fill this form out call Connecting Futures on:

(03) 5406 0438

Complaints can also be made through the following agencies. These agencies can also be contacted if the participant is not satisfied with the outcome.

National Disability Insurance Agency
by calling 1800 800 110 or visiting www.ndis.gov.au for further information.

Disability Services Commissioner
by calling 1300 880 043 or by visiting www.odsc.vic.gov.au.
Free support and advice is provided.

Disability Services Commissioner
Click here for online complaints form.


If you require advocacy please contact:

RIAC – Rights Information & Advocacy Centre

Phone: 03 5822 1944

Feedback or Complaint Form

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Who is completing this form?

Please let us know whether you are the NDIS participant yourself, or you are submitting this form on someone else's behalf.
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Do you wish to provide anonymous Feedback?

If you choose to remain anonymous we will not collect your personal information. Please note: that individual follow-up actions are not be possible for anonymous feedback.
NEXT: Select tab 2 to complete participant details.
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Participant Details

Please complete the contact information for the NDIS participant that this feedback/complaint relates to.
Please advise the preferred contact method and any other communication requirements.

Details of Person Submitting Form

Contact details of the person submitting the feedback/complaint on behalf of the NDIS Participant.

Anonymous Submission:
No Details Required

You have selected an anonymous submission, so we do not require any personal information from you.
Please note: we are unable to personally follow up on anonymous feedback. If you would like your complaint or feedback to be personally followed up on, with actions undertaken that relate specifically to you, then please uncheck the anonymous feedback option and submit a standard response.
NEXT: Click tab 3 to outline your feedback or complaint.

Your Feedback or Complaint

Please tell us what your major concerns or feedback are, including what led up to the complaint / feedback, approximate dates and who was involved or what you would like to provide feedback on.

Actions from Feedback

Please let us know what actions you would like to see happen from this feedback / complaint.
NEXT: Click tab 4 to confirm consent and submit.
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Please confirm your consent to contact you and share information.

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Consent for Information Sharing

Please advise whether you consent to information sharing relating to this complaint / feedback.
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Permission for Contact Person

Please advise whether you give permission for information sharing with the contact person named in this form.
NOW: Double check the information and submit your feedback / complaint.
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Thank You

Your feedback has been received. We will be in contact shortly to discuss your feedback.
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