Info form for NDIS Support Letter

NDIS Access Request Form - requires professionals to provide supporting information about your child’s disability and the impact it has on mobility, communication, social interaction, learning, self-care and/or ability to self-manage. Please answer the following questions with as much detail as possible to enable us to complete a support letter for NDIS.

Client Name

First NameLast Name

Person completing form

First NameLast Name

Relationship to child

Date

Impact of your child's disability...

1. Mobility/motor skills - Moving around the home (crawling/walking), getting in or out of bed or a chair, leaving the home and moving about in the community. Assistance required does not include commonly used items such as glasses, walking sticks, non-slip bath mats, bathroom grab rails and hand rails installed at stairs.

Does your child require assistance to be mobile because of their disability?

If yes, please describe the type of mobility assistance required:

Communication; Being understood in spoken, written or sign language, understanding others and express needs and wants by gesture, speech or context appropriate for age.

Does your child require assistance to communicate effectively because of their disability?

If yes, please describe the type of communication assistance required:

3. Social interaction - Making and keeping friends, interacting with the community (or playing with other children), coping with feelings and emotions.

Does your child require assistance to interact socially because of their disability?

If yes, please describe the type of social interaction assistance required:

4. Learning - Understanding and remembering information, learning new things, practising and using new skills.

Does your child require assistance to learn effectively because of their disability?

If yes, please describe the type of assistance required:

5. Self-Care - Showering/ bathing, dressing, eating toileting, caring for own health (not applicable for children under two years of age). Assistance required does not include commonly used items such as nonslip bath mats, bathroom grab rails and hand rails installed at stairs.

Does your child require assistance with self care because of their disability?

If yes, please describe the type of assistance required:

6. Self-Management - Doing daily jobs, making decisions and handling problems and money (not applicable for children under 8 years of age).

Does your child require assistance with self management because of their disability?

If yes, please describe the type assistance required: