Townsville Support Solutions

Support Coordination Intake Form

Complete this form to begin Level 2 Support Coordination services with Townsville Support Solutions

⚠️ IMPORTANT - Before You Begin:

To engage Townsville Support Solutions as your Level 2 Support Coordinator, you (or your nominee) must first call the NDIS on 1800 800 110 to endorse us as your support coordinator.

Please provide them with either:

  • Our NDIS Registration Number: 4050208893
  • Our ABN: 77 647 023 694

Once endorsed, complete and submit this form below.

📄 Prefer a Printable PDF?

Download our printable Support Coordination Intake Form, complete it, and return via email or mail.

📋 Personal Details

🚨 Emergency Contact

👥 Nominee / Guardian / Representative

📝 NDIS Plan Details

🤝 Current Supports & Services

🎯 Your Goals & Support Needs

✅ NDIS Endorsement Confirmation

* We cannot begin support coordination until the NDIS has been notified of your endorsement.

✍️ Consent

I consent to:

  • Townsville Support Solutions providing Level 2 Support Coordination services
  • TSS contacting my current service providers and supports (where necessary)
  • TSS liaising with the NDIS on my behalf regarding my plan
  • TSS storing my personal information in accordance with privacy regulations

By submitting this form, you are providing your electronic signature and consent to the above terms.

Please confirm NDIS endorsement before submitting

Need Help? Contact us at:

📞 (07) 4453 2220✉️ admin@townsvillesupportsolutions.com.au📍 1 Jones Street, Townsville

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