Please enable JavaScript in your browser to complete this form.Are you an NDIS participant?YesNoIf yes, please provide your name and surname: *NDIS number: *Representative name (if applicable):Start date of NDIS plan: *End date of NDIS plan: (copy) *Participant date of birth: *How do you pay your NDIS providers?I have a plan managerNDIASelf managedWhere would you like invoices sent to? (only relevant if plan managed)Address of the property to be serviced: *Email address: *Phone number: *Are there any days that are completely not available?MondaysTuesdaysWednesdaysThursdaysFridaysSaturdaysSundaysDo you require housekeeping services? *YesNoIf yes, please select the type of service(s) you require:Once off cleanRegular cleanSpring cleanBond cleanIf yes, please select your service frequency:Every WeekEvery 2 WeeksOnce a monthCustom frequencyIf yes, please select the size of your property:1 Bedroom2 Bedrooms3 Bedrooms4 Bedrooms5 BedroomsIf yes, please indicate the number of bathrooms in the property:1 Bathroom2 Bathrooms3 Bathrooms4+ BathroomsIf yes, please indicate the number of living rooms in the property:1 Living room2 Living rooms3 Living rooms4+ Living roomsIf yes, please select any extras that apply:OvenFridgeWallsBlindsWindowsCarpetsGutterOtherDo you require gardening services? *YesNoIf yes, how often do you require gardening services?WeeklyEvery 2 weeksEvery 4 weeksEvery 6 weeksEvery 8 weeksSpecific details:Where did you hear about us? *Word of mouthI searched on GoogleThe NDIS referred me to youAn Online Provider Finder ServiceI have used your services previouslyI have other participants utilising your serviceSocial MediaSubmit
