Getting started

Participant intake form

Tell us about yourself — or the person you support — so we can get started. Seven short steps, about 10 minutes. You can stop and come back on this device.

Step 1 of 7Who's filling this in?

Who
Participant
NDIS plan
Support
Health
Emergency
Review

Who's filling this in?

Before you start — how we use your information

Keystone Community Care (ABN 48 691 121 525) collects the information in this form to assess whether we can support you, plan and deliver NDIS supports, and match suitable support workers. Health, disability and cultural details are optional and are encrypted. We disclose information only to people involved in your care — for example your plan manager, support coordinator or the NDIA — with your consent, and never for marketing. You can ask to access or correct your information at any time via admin@keystonecommunitycare.com.au. See our Privacy Policy and how to make a complaint.

Which of these best describes you?

Your contact details

So we can get in touch with the person filling this in about this form.

First name

Last name

Phone

Yes, Keystone can contact me about this formWe'll use these details to follow up on this form — nothing else.

Prefer to do this over the phone? We can fill it in with you.Call 0403 886 293

We save your progress on this device while your browser is open. Health details are never saved on the device.

Encrypted at rest (AES-256)
Privacy Act 1988 compliant
About 10 minutes