My ResponsAbility

Referrals

Use this form to refer yourself or someone else to My ResponsAbility for disability and NDIS supports across the Sydney metropolitan area. We aim to respond within 1–2 business days.

If you are making this referral for someone else, we encourage you to involve the participant and complete the referral with them wherever possible. Submitting this form does not guarantee that My ResponsAbility can accept the referral or commence services.

This form is not monitored continuously, and My ResponsAbility is not an emergency, crisis or acute mental health service. If someone is in immediate danger, call 000.

Please provide only information relevant to this referral.

Make a referral

All questions are required unless marked (optional).

Who is completing this form?
Who is completing this form?
Participant details
Is an interpreter required? (optional)
Contact and consent
Who should My ResponsAbility contact first?
How would you prefer us to make contact? (optional)
When is the best time for us to contact you? (optional)

Choose as many as you like.

For example: please text before calling; email is preferred; do not leave a voicemail.

Support requested
What support is being requested?

Select all that apply.

Expressions of interest (optional)

Select any you would like to register interest in. These are not currently available services.

Approximate support required
How often might support be needed? (optional)
Approximately how many hours may be needed each week? (optional)
When is support needed?
When is support needed?
NDIS plan and funding
Does the participant currently have an NDIS plan?
Important information before contact
Is there anything important we should know before contacting or meeting the participant?
Privacy acknowledgement

My ResponsAbility Pty Ltd collects the information provided through this form to review the referral, contact the nominated person, assess service fit and capacity and, if the referral proceeds, plan and provide appropriate disability supports.


The information may include personal, disability or health information. Please provide only information relevant to the referral.


If you are referring someone else, we encourage you to involve the participant wherever possible. Where appropriate consent or authority has not yet been confirmed, please provide only the minimum information needed for My ResponsAbility to make initial contact.


Information may be accessed by authorised My ResponsAbility personnel and shared where reasonably necessary for the referral or support, with appropriate consent or authority, or where otherwise permitted or required by law.


If you do not provide enough information, My ResponsAbility may not be able to assess or respond to the referral.


For more information, including access, correction and privacy complaints, please read our Privacy Policy or contact [email protected] or 02 7205 4859.

Opening hours

  • Monday to Friday: 9:00 – 17:00
  • Saturday and Sunday: 10:00 – 14:00

We aim to respond to referrals within 1–2 business days.

To give feedback or make a complaint, see:
Feedback & Complaints.