Module 2A Positive Behaviour Support Referral

Positive Behaviour Support helps participants and their support networks understand behaviours of concern and build proactive, person-centred strategies that improve quality of life.

Our Module 2A referral pathway connects participants with the right support to get started.

About This Referral

This referral is for participants, families, carers, and professionals seeking support in implementing Positive Behaviour Support strategies under Module 2A. Our team works with you to ensure the referral captures accurate, up-to-date information so we can respond effectively and connect you with appropriate support.

Submit a Referral

Please complete the referral form below with as much detail as possible. Fields can be updated at any time as circumstances or needs change.

Participant Profile

Participant Name

First

Last

NDIS Number

NDIS Plan Start Date

NDIS Plan End Date

Date of Birth

Country of Birth

Gender

OR self-describe (Gender)

Aboriginal or Torres Strait Islander

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Participant Phone (if applicable)

Participant Email (if applicable)

Disability or Diagnosis

Goals (in brief)

Nominee / Emergency Contact Details

Primary Contact

Relationship to Participant

Phone

Email Address

Secondary Contact

Relationship to Participant

Phone

Email Address

Relevant Clinical / Background Information:

Primary disability, reason for referral, goals, current mobility/communication/functional capacity, current carer support, current living arrangements, etc.

File Upload (Please attach a copy of the current NDIS plan if possible)

Drag & Drop Files, Choose Files to Upload

Advocacy & Support Contacts

If you need independent advice, advocacy or to raise a concern, the following organisations can help:

Mental Health Complaints Commissioner

Telephone: (03) 9032 3328
Toll Free: 1800 246 054
TTY: 1300 582 113 Level 26, 570 Bourke Street, Melbourne VIC 3000

Ombudsman Victoria

Telephone: 1300 362 072
Level 6, 34 Queens Street, Melbourne VIC 3000

Equal Opportunity Commissioner

Telephone: 1300 292 153
TTY: 1300 289 621
Level 3, 204 Lygon Street, Carlton VIC 3053
Privacy Commissioner: 1300 363 992
www.privacy.gov.au

National Disability Abuse and Neglect Hotline

Toll Free: 1800 880 052
TTY: 133 677

Disability Services Commissioner

Toll Free: 1800 677 342
TTY: 1300 726 5653
Level 20, 570 Bourke Street, Melbourne VIC 3000

Offices of the Public Advocate

Telephone: 1300 309 337
TTY: 1300 305 612
Level 1, 204 Lygon Street, Carlton VIC 3055

Ready to Refer?

Submit your Module 2A referral today or contact our team on 0449 944 758 if you have any questions before you begin.