Transport Referral Form

Refer an NDIS Participant for Wheelchair-Accessible Transport

Whether you’re a support coordinator, family member, healthcare professional, or referring yourself, complete the form below and our team will review the referral and get in touch to discuss the participant’s support needs and next steps.

NDIS Transport Referral

Refer yourself, a family member, or a participant you support — our team will follow up to discuss next steps.

Full Name

Email Address

Phone Number

Date of Birth

NDIS Participant Number (if known)

Residential Address

Regular Pick-up Address (if different to residential)

Regular Drop-off Address (if applicable)

Which best describes you?

Support Coordinator or Agency Name (if applicable)

How is your NDIS plan managed?

Preferred contact method

Do you require wheelchair access?

Will you remain in your wheelchair during travel?

Vehicle requirement

Does a carer or family member travel with you?

Do you receive Passenger Transport Subsidy Scheme (PTSS)?

If yes, which PTSS category?

How did you hear about us?

Any additional information

I consent to being contacted regarding my enquiry. View Privacy Policy

0410 003 798

Transport Referral Form

Refer an NDIS Participant for Wheelchair-Accessible Transport

NDIS Transport Referral

EmpowerOne Support Services

Quick Links

Other Links

Contact Information