Participant Sign Up

Complete the form below to get started with Dedicated Plan Management. Any questions, or need help signing up, give us a call to assist 1300 010 170.

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NDIS Participant Sign Up Form

Fields marked with * are required.

Email Address

Participant First Name

Participant Last Name

Participant Date of Birth

Phone Number

NDIS Number

Representative / Parent / Carer Details

Is there a Participant Representative / Parent / Carer?

Yes No

Address Details

Street Address

Suburb

State/Region

Postal Code

More Details

I/We are:

New to the NDIS Wanting to change plan managers Existing Participant with No Plan Manager

PDF only, maximum 10MB.

How did you hear about us?

Service Agreement

I have read and agree to the terms and conditions of this service agreement.

We typically respond within 2 hours. Please expect a phone call.