Welcome to Alignment Care

About the participant

A few basics to get started. Tap "use contact info" when your phone offers it.

Who's filling this in?

I'm the participantFilling this in for myself Family member or nomineeFilling this in on behalf of the participant Support coordinatorReferring a participant to Alignment Care

Please select one.

Participant's full name

Full name is required.

Preferred name

Date of birth

Date of birth is required.

NDIS number Found at the top of your NDIS plan.

NDIS number is required (9 digits).

Mobile

Mobile number is required.

A valid email is required.

Home address

Address is required.

NDIS plan

How your plan is managed affects how we invoice.

How is the plan managed?

Plan-managedA plan manager pays our invoices on your behalf Self-managedYou receive and pay our invoices directly, then claim from NDIA NDIA-managedNDIA pays providers directly

Please select one.

Plan manager — business name

Plan manager name is required.

Plan manager — invoicing email We send invoices here.

Plan manager email is required.

When does your current plan end? Skip if unsure — you can email a copy of your plan later.

Do you have a support coordinator?

Care needs

What supports you're after and anything a carer should know.

What supports do you need? (tick all that apply)

Personal careShowering, dressing, grooming, toileting Community accessSocial outings, appointments, activities Domestic assistanceCleaning, laundry, meal prep, shopping TransportTo appointments or activities, in carer's vehicle OtherDescribe below in the safety notes

Please select at least one.

When do you need support?

Please describe when you'd like support.

What should a carer know to keep you safe and comfortable? Don't worry about listing everything — we'll cover more at the home visit.

Please share a few notes for carer safety.

Emergency contact & consent

Almost done.

Emergency contact — name

Emergency contact name is required.

Relationship to participant

Relationship is required.

Emergency contact — phone

Emergency phone is required.

Preferred gender of carer

Female Male No preference

Please select one.

Please tick to consent.

✓

Thank you

Your details have been received. James will be in touch within 48 hours to arrange a home visit and draft your service agreement.

If you need to reach us in the meantime: jamescmcrae@gmail.com · 0401 540 189