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Referral Forms

Choose the referral form that matches the support you need below: NDIS Services, Aged Care at Home Support, SDA Housing Solutions, or Training. Complete the form and our team will be in touch.

1. NDIS Services Referral

Who is filling out this form?*

Participant

Guardian

Support Coordinator

Staff Member

Family Member

Friend

Other

Who is this referral for?*

Self

Child

Adult participant

Other

NDIS plan management*

Self-managed

Plan-managed

Agency-managed

Not approved yet

Not sure

Referrer first name*

Referrer last name*

Referrer email*

Referrer mobile*

Participant first name*

Participant last name*

2. Aged Care at Home Support Referral

Referral number*

Enter the referral number shown in the decision letter.

Referrer first name*

Referrer last name*

Organisation or relationship*

Referrer email*

Referrer mobile*

Participant name*

Age

Date of birth*

Day

Month

Year

Address*

3. SDA Housing Solutions Referral

Inquiry type*

Available house

Upcoming house

Not sure

Applying for*

Self

Representative

First Name*

Last Name*

Email*

Mobile*

NDIS number*

State*

Suburb or area*

Age*

4. Training Referral

Peers Healthcare Providers Pty Ltd (PHP) is the trading name for Five Rivers Business Group’s NDIS and Aged Care services.

Aged Care at Home support is provided in partnership with TrilogyCare. TrilogyCare manages administration, while direct care is delivered under the trading name Peers Healthcare Providers Pty Ltd (PHP).

© 2026 The Trustee For 5 Rivers Business Group. All rights reserved.
ABN: 98 960 924 919
ACN: 650 628 121 Peers Healthcare Providers
NDIS registered provider. SIL and SDA services are delivered through our registered and approved service arrangements.
Peers Healthcare Providers Pty Ltd (PHP) is the trading name for relevant NDIS and aged care services.

South Australia Office
20 Paynham Road, Stepney SA 5069, Australia
Phone: 0468 346 505

Victoria Office
4 Butternut Street, Harkness VIC 3337, Australia
Phone: 0468 406 505
info@peershealthcare.com.au

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