Please fill out the form below in order to use your NDIS funding with our clinic. A team member will then be in touch with you within 1 business day.

What NDIS services do you require? *
Please select all that apply.

NDIS Participant Details (who the nutrition advice is for):

Please enter the name of the person needing nutrition advice.
NDIS Participant Gender
Please select one.
Please put the address where the NDIS participant resides.
Please input the NDIS participants best contact phone number.

Please complete if you are filling out this form on behalf of an NDIS participant:

The name of the person completing this form on behalf of the NDIS participant. Please fill this out if you are a parent or carer of an NDIS participant.
Please outline your relationship to the NDIS participant.

NDIS Plan Details

We require this for invoicing purposes.
Who manages the NDIS Funding?
Who is the person who manages your funding and pays for your services?

*Please note that self-managed appointments must be paid for at the time of the consultation. You will be provided an invoice for reimbursement from the NDIS.

Please provide details for invoicing:

Who coordinates appointment bookings?
Please enter the details of the person who in involved in booking appointments and receiving appointment confirmation and reminders.

If other, please provide details for the person managing booking (this person will receive appointment confirmations emails and reminders):

How can we support you?

How did you hear about The Healthy Eating Clinic? *

Agreements

When you book an NDIS appointment with The Healthy Eating Clinic you will be required to agree to and sign a separate service agreement outlining the conditions of NDIS services provided by The Healthy Eating Clinic. 

I have read and agreed to The Healthy Eating Clinic's NDIS Policy.

I have read and agreed to The Healthy Eating Clinic's Privacy Policy.

I have read and agree to The Healthy Eating Clinic's Cancellation Policy.