Make A Referral

We will focus on helping you understand how Everyday Independence works, what services and support are available and build resources to help improve your participation and transparency across the process.

Fill out the form to make a referral and one of our team members will contact you shortly to discuss the next steps.

We also accept referrals in two other ways:

Call Us: 1300 179 131

referral@everydayind.com.au

Everyday Independence is open and our therapists continue to offer support in-person with strict safety measures in place, and over the phone. We are pleased to now offer online appointments for people to connect with their therapist via video.

All 19 therapy hubs in Victoria, Sydney and Newcastle in New South Wales and the Gold Coast remain open for appointments.

1. Client's Details -

Client's Details
First Name*
Last Name*
Phone Number*
Address
Suburb
Postcode
Date of Birth
NDIS participant number (if applicable)
Please provide a brief description of the support required, goals and needs of the person including diagnosis if relevant*
- Next

2. Referrer Details +

Referrer's Details

First Name*

Last Name*

Name of the Organisaton*

Job Title*

Phone Number*

Email*

Any Risks or Issues?*

* Are there any environmental, behavioural or other issues we should be aware of? If so please indicate below and we will contact you to discuss so we can provide therapy in a safe and supportive way.

How did you hear about us?

1. Client's Details -

2. Referrer Details +