Request
Support

1Request for Service

2Potential Participant Information

3Family/Other Circle of Support Information

4Service Request Details

5Reason for Referral

Important information - please read carefully

Completing a request for service form does not guarantee that Lancaster Consulting Australia (LCA) will be able to provide support for the individual being referred. As we are experiencing a high number of requests for services, our review process is focused on clients with very complex needs.

Lancaster Consulting Australia does not currently have an active waitlist and we are reviewing each request for service on a case by case basis. This is subject to change at LCA Directors' discretion.

Our eligibility requirements are generally based on (but not limited to) the following aspects:
- Clients with very complex, intersecting needs.
- Clients who are referred by Child Protective Services, VALID, NDIS complex pathway teams etc.
- Clients with multi-sector involvement.
- Clients whose behaviours put them at risk to themselves, those around them (e.g. support staff and family members) and the general community.
- Clients who are at significant risk of homelessness.
The information provided in the request for service is reviewed by LCA Directors, who will make a decision on suitability for services. We will then advise of the outcome in due course. Any timeframe provided for potential service provision is an estimate only and may also be subject to change.

Potential Participant Information
Name*
First Last
Date of Birth*
DD slash MM slash YYYY
Gender*
Address*
Street Address Address Line 2 Suburb State Post Code
NDIA Participant Number*
NDIA Plan Start Date*
DD slash MM slash YYYY
NDIA Plan End Date*
DD slash MM slash YYYY
Primary Disability/ies*
Other Disabilities
Does the person identify as an Aboriginal or Torres Strait Islander?*
Does the person come from a culturally diverse background? If so, what is that background?*
Is an Interpreter required?*

Potential Participant Information