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Account Type

NDIS Participant Details

Please enter the details of the NDIS Participant below. Note: If you are a plan manager or support co-ordinator you will need to create an account for each NDIS Participant you are managing.

Participant Name *

Participant DOB *

Participant Phone

NDIS Account Information

NDIS Account Type *

Please select an account type:
NDIS Agency Managed: For accounts managed through the NDIA who pays on your behalf.
NDIS Plan Managed: For accounts managed through a Plan Manager who pays your providers for you.
NDIS Self Managed: For accounts managed by you, the participant, who receives funds from the NDIA directly.
For more information, click here

NDIS Number *

Please enter the NDIS Number of the NDIS Participant.

Plan Manager *

Search for your Plan Manager from the dropdown below. If you cannot locate them please select the 'Other' option.

Plan Manager Name (Other)

Plan Manager Phone

Plan Manager Email *

Support Coordinator *

Support Coordinator Name *

Support Coordinator Phone

Support Coordinator Email *

HCP Account Information

HCP Provider *

HCP Provider Name *

HCP Provider Email *

HCP Provider Phone

Case Manager Name

Case Manager Phone

Case Manager Email

Are you an authorised nominee?

If you are not the participant completing this form, please complete authorised nominee details below.

Authorised Nominee

Name

Relation to participant

Other (please specify)

Organisation (if applicable)

Phone

Do you have an email address? *

First Name *

Last Name *

Email address Required

Password Required

Confirm Password

Your personal data will be used to support your experience throughout this website, to manage access to your account, and for other purposes described in our privacy policy.