Contact

Full Name *

NDIS Number *

Date of Birth

Phone Number *

Email Address *

Residential Address *

NDIS Plan Information

What type of NDIS plan do you have? *
NDIA ManagedPlan ManagedSelf Managed

NDIS Plan Start Date

NDIS Plan End Date

Do you have funding available for Home Maintenance?
YesNoUnsure

Plan Manager Details (If Applicable)

Plan Manager Company Name

Plan Manager Contact Person

Plan Manager Email

Plan Manager Phone Number

Service Request Details

What maintenance service do you require?

Please describe the work required *

How urgent is this request? *
Low (1–2 weeks)Medium (few days)High / Safety Issue (ASAP)

Property Information

Is the work required?
Inside the HomeOutside the HomeBoth

Property access type *
Easy accessApartment / stairsGated propertyRural / difficult access

Are there any access restrictions?
NoYes

If yes, please specify

Are there stairs at the property?
YesNo

Is parking available on-site?
YesNo

Health & Safety Information

Are there any known hazards we should be aware of?
Heights required (ladder work)Electrical risksWater leakageStructural damageNo known risks

If yes, please provide details

Are there pets on the property?
NoYes

If yes, please specify

Will a support worker be present?
YesNo

Who will be present during the service visit?
ParticipantFamily MemberSupport WorkerOther

📂 FILE SUBMISSION STATUS – EMAIL & GOOGLE DRIVE

Please tick ALL that apply:

📸 I have emailed Photos to hello@hellowhs.com.au🎥 I have emailed Videos to hello@hellowhs.com.au📄 I have emailed NDIS Plan📑 I have emailed Support Documents📁 I have uploaded ALL files to Google Drive and pasted the link below

📁 Google Drive Upload

Upload your files to Google Drive and paste the link below:

👉
Open Google Drive

Paste your Google Drive link here *

⚠️ Make sure your link is set to "Anyone with the link can view"

📧 Email Option

Send files directly to:
hello@hellowhs.com.au

👉
Click here to Send Files via Email

Please include your Full Name + NDIS Number in the email subject.

🤖 NDIS Intake System Notice

Your request will be processed through our NDIS Intake System.
We may contact you if additional information is required before quoting.

Service Scheduling

Preferred Service Date

Preferred Time
MorningAfternoonFlexible

Consent

I confirm that the information provided is accurate and complete. I understand this is a request for quotation only and work will not commence until approval is given in accordance with NDIS guidelines.