Lead Management – Raas Designs

Your NDIS Plan

Have you provided a full copy of the NDIS Plan to us? *

Yes

No

For Journey Connect to provide an accurate service agreement it is recommended you provide us a copy of your NDIS Plan. You can blank out sensitive information such as budgets as Journey Connect only quote to the need. It is your responsibility to ensure that the quote/service agreement we provides fits into the Plan Budget.

Upload your NDIS Plan for us to review *

NDIS Plan Start Date This is found on your NDIS Plan (If you have provided a copy of your plan or you have uploaded, you can leave blank)

NDIS Plan end date This is found on your NDIS Plan (If you have provided a copy of your plan or you have uploaded, you can leave blank)

Your supports

Other

Tell us a bit about the supports you are needing* This could be: I need help with daily activities such as personal care, assisting with cleaning. OR I want to go out into the community 3 days per week.

Hours per week or total hours over the plan period If you know how many hours you are wanting supports, please enter either the weekly hours or the total number of hours over the plan period.

Please select how you have described the hours

Per Week

Over the plan period

How is your Plan Managed?

Plan Management (for payments)

Registered Plan Manager

NDIA Managed

Self-Managed

Plan Nominee

Registered Plan Manager Business Name

Registered Plan Manager Email *

Registered Plan Manager Phone

Self Managed Invoice Email Address *

Nominee Name

Nominee Email (for invoices) *

Nominee Phone

Enquirers Details

About the Participant

Your NDIS Plan

Your supports

How is your Plan Managed?