NDIS Referral

The Team at Paragon PsychConnect provide a comprehensive assessment and treatment service for people eligible for NDIS services if you are self-managed or plan managed.


Once you complete and submit the NDIS Referral form, the completed form will be sent to us, and emailed to you.

We will then contact you to discuss your needs.


Alternatively, if you cannot complete the online form below:

  • Either download and fill in a NDIS Referral PDF Form.  Then either email, or fax (08 7095 3485), it to us, or have a printed version brought to the appointment.
  • Or you can ring ( (08) 7095 3484), or fax (08 7095 3485), our office to make an appointment.
  • Or you can contact us by submitting an enquiry and we will contact you as soon as possible.


Please note:

  • The required fields in the form below are marked with a red asterisk *.
  • If you cannot complete the form, an email will be sent to you after a time, with a web link to finish the form if you wish.  The Client First Name and Client Email Address must be entered for this to work.
Referral Form NDIS
  • Client Details
  • Referrer Details
  • Plan Funding Details
  • Referral Details
  • Referral Details
    • Submit Form

    NDIS Referral Form

    Client Details

    Client Title
    Client Address *
    Client Address
    0 of 1000 max characters
    Is an Interpreter Required?