Participant Intake

Intake Form

Name: Ballarat Support Services
Address: 901b La Trobe Street, Delacombe, VIC, 3356, AU
Telephone: +61411963244

The deeper-dive form we use during onboarding — covers medical, risks, NDIS funding, goals, and supports needed. Fill what you can; an intake officer will review with you before services begin.

Participant Intake Form

Complete Your Intake

Please complete every section. If a question doesn't apply, mark it N/A. Required fields are marked with *. You can also download the PDF version if you'd prefer to fill it in offline and email it back.