Careseekers

Provider Partner Referral Program

Hi there! There is a form which will help us to understand your client. This is all the information we need to find the best suited worker for your customer. Please fill in as much information as you can.

All private client information is secured safely on our platform.

Your email

Your phone

Has the client signed your contract?

Yes

Are you exclusively using Careseekers for the referral?

Yes

Client name (internal use only)

When does this service need to start?

Client's Address

Suburb

What days do you need a worker?

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Flexible/Unknown

What times do you need the worker? (If no specific times please list number of hours per day)

What kind of services does the client need help with?

Press Ctrl and Click / ⌘ and Click to select multiple options

Does the worker need a car for this service?

Yes

Are there any language requirements?

What is the hourly rate for this service?

Do you have a preference for male or female workers?

Male

Female

Either

How old is your client?

Do the workers need to have any specific experience?

Any personality traits of the worker that works well with the client?

Anything else about the client we should know?

Is this an NDIS or Aged Care Client?

Aged Care

NDIS

Other

If your client is an NDIS client, you MUST answer the below

Self-Managed

Plan Managed

Agency Managed

N/A

Give us a description of their diagnosis

Are there any behaviours of concern or BSP in place? Please give a brief explanation

Does this client have any restrictive practices in place?

Yes

Please attach the Behaviour Support Plan or the Risk assessment

Fields marked with * are mandatory

Submitting your responses, please wait...

A copy of your responses will be emailed to the address you provided.

For assistance please contact our Community and Partnerships Manager on 0431163669 or partnerships@careseekers.com.au

1300 765 465