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Welcome

I understand and agree to share this information to support my journey of Discovery.

About Me

Full name*

Preferred name

Date of birth

Day

Month

Year

Phone number

Email address

NDIS participant number

Who helps you most right now?

My Life Right Now

Where do you live?*

With family

On my own

With others

Supported accommodation

Other

What does a typical day look like for you?

What do you enjoy doing most each week?

Are there things you’d like to do more often?

How do you usually get around?

Walk

Bike

Bus / Train

Car

Taxi / Uber

Support worker transport

Other

My Strengths and Interests

What are three things you’re good at?

What activities make you feel proud or happy?

What do others say you’re good at?

What skills or talents would you like to develop?

My Community & Connection

Who are the most important people in your life right now?

What places or groups make you feel welcome?

Are there any local activities you’d like to join?

Do you need help connecting with your community?

Yes

No

Not sure

My Health & Wellbeing

How would you describe your overall health?

Poor

Fair

Okay

Good

Excellent

What helps you feel calm, happy, or balanced?

Are there things that make you feel stressed or anxious?

Would you like help with any of these?

Daily routines

Exercise or movement

Eating well

Sleep and rest

Managing stress

Confidence and motivation

Other

My Learning & Goals

What would you like to learn or try in the next few months?

Are you interested in:

Work

Volunteering

Study / training

Community projects

Not sure yet

What kind of environment suits you best?

Quiet

Busy

Indoors

Outdoors

Hands-on

Computer-based

With people

Independent

If you could create your ideal week, what would it look like?

What are your top 3 goals for the year ahead?

Challenges & Support Needs

What things make life harder right now?

What kind of support helps you the most?

Where would you like more help?

Daily living skills

Community access

Employment / study

Health / wellbeing

Confidence & motivation

Relationships / social skills

Other

Next Steps

Would you like to book a Discovery Conversation?

Yes, please

Not yet

I’d like more info first

Upload any files or photos you’d like to share

Best way to contact you

Call

Text

Email

Thank you for sharing your story — your Discovery partner will be in touch soon.

Contact Us

Referral Form

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