Referrals
Participant Pre-Screening and Suitability Assessment Form:
Purpose and Instructions
The Participant Pre-Screening and Suitability Assessment is designed to help us understand your unique situation and determine if XYSTON’s Support Coordination services are the right fit for your NDIS goals. This process allows us to ensure we can provide the safe, high-quality, and capacity-building support you deserve.
Completing this form is an essential step in our intake process. It enables us to identify how best to support you and ensures we are fully prepared to meet your specific needs. All information submitted is treated with strict confidentiality in accordance with the Privacy Act 1988 (Cth).
Purpose of the Pre-Screening Form
Ensuring the Right Fit
We use this assessment to confirm that our team possesses the specific expertise and operational capacity required to help you achieve the goals outlined in your NDIS plan (Section 2).
Understanding Your Needs
This process allows us to gain a holistic view of your support requirements. By reviewing the details and reports you provide, we can ensure we fully understand your situation (Section 3).
Supporting Your Safety
We carefully review any health, safety, or behavioural considerations you share. This is essential for creating a supportive service environment that prioritizes your well-being (Section 4).
Transparency & Consent
We want to ensure you are fully informed about how we operate. This section covers important acknowledgments, including how we manage conflicts of interest (Section 5).
Instructions for Completion and Submission
Instructions for Completion
Please complete all relevant sections of this form to the best of your ability.
Helpful Documents: To help us assess your application quickly, we recommend having digital copies of the following documents ready to upload: Current NDIS Plan (Highly Recommended), Medical or Allied Health Reports (e.g., Functional Capacity Assessments), Safety or Behaviour Plans (if applicable), and Guardianship Orders (if applicable).
Acknowledgments: The form includes several checkboxes to ensure you understand our intake process. Please review these carefully.
Electronic Signature: In the final section, simply typing your full name will serve as your confirmation that the information provided is accurate.
If you require assistance or an alternative format (such as Easy Read), please contact our administration team.
Post-Submission Process
Review and Verification Our intake team will conduct a detailed review of your submission, including your NDIS plan and uploaded reports. This ensures that XYSTON has the capacity, registration, and expertise to meet your specific support needs.
Follow-up Communication Should we require further context regarding your goals, safety considerations, or medical history, we will reach out to you or your nominee promptly to clarify these details before proceeding.
Next Steps If our services are confirmed as a suitable fit, we will arrange an initial intake meeting. During this session, we will formalise our partnership through a Service Agreement and begin mapping out your personalised support journey.