Skip to content
1300 721 964
Register
Login
Home
Our Services
How it Works
Our Story
Pricing
Make a Referral
Careers
Blog
Contact
Contact
Register
Login
Navigation Menu
Home
Our Services
How it Works
Our Story
Pricing
Make a Referral
Careers
Blog
Contact
Final Registration
Upload
for dev purposes, dont' delete
Thank you for registering with Stream Services. If you’re a current member please
sign in
, otherwise fill in the form below.
I am completing this on behalf of an NDIS Participant
*
Yes
No
Personal Details of NDIS Participant
My first name is
*
My last name is
*
My phone number is
*
Required phone number format: ##########
My e-mail address is:
*
My date of birth is
*
Select your region
*
Non-remote
Remote
Very remote
I don't know and I would like to speak to about this after I complete this form
(Check Map)
Remote is a location zoned Modified Monash Model 2015 Zone 6 or communities surrounded by MMM6 area, Very Remote is MMM7 areas. See NDIS Price Guide for more information about NDIS zoning
My address is:
Address
*
Town / City
*
State / County
*
Select an option…
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Postcode
*
My gender is
*
Male
Female
Other
The main language I speak at home is:
Do I require an interpreter (Oral, Auslan, Tactile Interpreter)?
*
Yes
No
My Living arrangements are
I would rather not say
I live with family
I live in a supported home (service provider provides supports all day every day in my home)
I live by myself
I live with friends
The names and relationships to me of the people who live with me are
Eg: Sarah (sister), Steph (friend from school)
Do I have any guardianship or custody orders in place?
*
Yes
No
Trusted Person
Please enter the details of your trusted person or emergency contact
The name of my trusted person is:
*
This person is my (Example: friend, partner)
*
This person's email is
This persons phone number is
*
Required phone number format: ##########
My NDIS Information
Do you have an NDIS plan?
*
Yes
No
My Medicare card expiry date
NDIS plan start date
NDIS plan end date
What is my primary impairment / disability?
(Note for multiple impairments/disabilities)
If you have multiple disabilities please note the others below. The Primary impairment is an NDIS term which is the impairment or disability which impacts upon your day to day life the most
Do I have a history of challenging behaviours or risks related to self harm or harm to others?
*
Yes
No
Please answer where applicable: I have a history of the following mental health or health diagnosis conditions other than any impairment mentioned above.
I have the following allergies
I have the following phobias (if any) you should be aware of
Do you want to write or upload your goals?
*
Write
Upload
My NDIS Plan
What services am I interest in from Stream Services?
*
Occupational Therapy
Psychology
Exercise Physiology
Dietetics
Coordination of Supports
Lifestyle Support Worker
Don't worry if you are not sure your answer is correct, you can change this any time in the future, your coordinator or one of our helpful staff can assist you if you are unsure.
number dev select
yes
no
test
My NDIS Plan (continued)
I have read and understand the
Service Terms and Conditions
.
*
Agreement
Username
*
Is there any other information you think we should know
How would you like us to contact you?
*
Text/SMS
Email
Both
Nominate frequency of notifications
After every shift
Once per day
Would you like to add another email address to receive all of your Stream Services correspondence?
Create a password:
*
To create your password, type it into the box above. If you forget your password or have trouble accessing your account, you can always contact us for help.
Please note, all information is stored on Australian servers, in accordance with Australian Privacy Principles
Upload
for dev purposes, dont' delete
Thank you for registering with Stream Services. If you’re a current member please
sign in
, otherwise fill in the form below.
I am completing this on behalf of an NDIS Participant
*
Yes
No
Personal Details of NDIS Participant
My first name is
*
My last name is
*
My phone number is
*
Required phone number format: ##########
My e-mail address is:
*
My date of birth is
*
Select your region
*
Non-remote
Remote
Very remote
I don't know and I would like to speak to about this after I complete this form
(Check Map)
Remote is a location zoned Modified Monash Model 2015 Zone 6 or communities surrounded by MMM6 area, Very Remote is MMM7 areas. See NDIS Price Guide for more information about NDIS zoning
My address is:
Address
*
Town / City
*
State / County
*
Select an option…
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Postcode
*
My gender is
*
Male
Female
Other
The main language I speak at home is:
Do I require an interpreter (Oral, Auslan, Tactile Interpreter)?
*
Yes
No
My Living arrangements are
I would rather not say
I live with family
I live in a supported home (service provider provides supports all day every day in my home)
I live by myself
I live with friends
The names and relationships to me of the people who live with me are
Eg: Sarah (sister), Steph (friend from school)
Do I have any guardianship or custody orders in place?
*
Yes
No
Trusted Person
Please enter the details of your trusted person or emergency contact
The name of my trusted person is:
*
This person is my (Example: friend, partner)
*
This person's email is
This persons phone number is
*
Required phone number format: ##########
My NDIS Information
Do you have an NDIS plan?
*
Yes
No
My Medicare card expiry date
NDIS plan start date
NDIS plan end date
What is my primary impairment / disability?
(Note for multiple impairments/disabilities)
If you have multiple disabilities please note the others below. The Primary impairment is an NDIS term which is the impairment or disability which impacts upon your day to day life the most
Do I have a history of challenging behaviours or risks related to self harm or harm to others?
*
Yes
No
Please answer where applicable: I have a history of the following mental health or health diagnosis conditions other than any impairment mentioned above.
I have the following allergies
I have the following phobias (if any) you should be aware of
Do you want to write or upload your goals?
*
Write
Upload
My NDIS Plan
What services am I interest in from Stream Services?
*
Occupational Therapy
Psychology
Exercise Physiology
Dietetics
Coordination of Supports
Lifestyle Support Worker
Don't worry if you are not sure your answer is correct, you can change this any time in the future, your coordinator or one of our helpful staff can assist you if you are unsure.
number dev select
yes
no
test
My NDIS Plan (continued)
I have read and understand the
Service Terms and Conditions
.
*
Agreement
Username
*
Is there any other information you think we should know
How would you like us to contact you?
*
Text/SMS
Email
Both
Nominate frequency of notifications
After every shift
Once per day
Would you like to add another email address to receive all of your Stream Services correspondence?
Create a password:
*
To create your password, type it into the box above. If you forget your password or have trouble accessing your account, you can always contact us for help.
Please note, all information is stored on Australian servers, in accordance with Australian Privacy Principles
