NDIS Order Form

For people with agency-managed NDIS plans, please complete the below form for your order to be paid via the NDIS My Place Portal. We will process your order once the form has been completed.

This form is also provided onscreen with your order confirmation page, and as a link in your order confirmation email.

Please use this form to provide the ADDITIONAL information for an order you have placed on our website if you wish us to process the payment via the NDIS MyPlace Provider Portal. We can do this for NDIS-managed plans. Please note that if you have a plan manager, we usually cannot process the payment via the MyPlace Portal, as it needs to be paid by a plan manager. In this case, we will email you that we have not been successful in processing the order, and to please send the invoice to your plan manager.

Order Number*
What is the order number for the order you have just submitted on our website?
Order Placed By*
First Last
If the order is not in your name, please provide your own details.
Orderer's Email
Orderer's Business Name*
If applicable
Orderer's Phone*
Are you the NDIS Participant?*
Click YES if the NDIS Plan to be used for this order is in your own name. If NO, please confirm permission to order for the Participant, and complete details for you as the orderer
Participant’s Full Name*
First Last
What is your relationship to the Participant?*
Therapist Type
If Other, please explain
Please confirm that you have permission to order for the NDIS Participant?*
Date of Birth*
Date Format: DD slash MM slash YYYY
NDIS number*
Please enter the 9 digit NDIS Number
NDIS plan end date*
Date Format: DD slash MM slash YYYY
Please select the budget category as shown on your NDIS Plan*

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NDIS Order Form

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