Enquiries Complete this form if you would like to use The Star Care Group’s services.For more information, contact our Services Management Team on:Ph. 08 9242 3276/ Email: info@thestarcaregroup.com.au Participant Name * Participant's Date of Birth or Age * Participant Gender * Participant's Suburb/Location * Disability Type * Medical Condition * Email * Phone Number * I am a... * Person with disabilityFamily memberSupport CoordinatorLegal GuardianOther Who are you referring? * Select an optionMyselfFamily memberClientFriendOther Do you/the individual you are representing have an NDIS plan? * YesNoUnsure What is your/their funding source? * National Disability Insurance Scheme (NDIS)Disability Support for Older Australians (DSOA)Insurance Commission of Western Australia (ICWA)iCareFunds in CourtDepartment of Child Protection (DCP)Department of CommunitiesPrivate FundingUnsureOther funding source What services are you looking for? * (You can choose multiple) Assistance with Daily LivingAssistance with Community ParticipationSupport Coordination/Specialist Support CoordinationPsychosocial Recovery CoachingMental Health SupportEmployment SupportShort Term RespiteHome and Community Support in Supported AccommodationSupported Independent Living (SIL)SIL + Specialist Disability Accommodation (SDA)Medium Term Accommodation (MTA)Individualized Living Options (ILO)Occupational TherapyPhysiotherapyContinence Nursing Is a wheelchair accessible vehicle required for community outings? YesNo If you require SDA, select your NDIS-approved accommodation category. Improved LiveabilityRobustFully AccessibleHigh Physical Support How did you hear about us? * Social MediaGoogleSupport Coordinator/Plan ManagerWord of MouthEmail from The Star Care GroupPost/MailEvents/ExpoRadioOther Other Information