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Access Request Form

Information required to be completed by the Participant:

  • Personal Details
  • Your privacy and consent to collect and share your information
  • How would you like the NDIA to contact you?
  • Parent, legal guardian or representative details (if applicable)
  • Information about your carers and family members (if applicable)
  • Your disability, or need for early intervention supports
    • Always list the disability that has the most affect on your daily functional life first.
    • Then list the disabilities that affect your functional abilities on a daily basis. 
      • These need to be listed in order of most affect on your functional abilities on a daily basis to least.
    • It is also worth listing major functional limitations (Secondary conditions)
  • The section “We need supporting information about your disability and the impact it has on your mobility, communication, social interaction, learning, self-care and/or ability to self-manage.”
    • If possible this is best completed by a Professional, for example
      • General Practitioner
      • Medical Specialist
      • Paediatrician
      • Psychologist
      • Psychiatrist,
      • Educational Professional, etc