What sets Brave Minds apart from other support service providers?

At Brave Minds, we don't just meet industry standards — we exceed them. All our staff members have a minimum of five years' experience in mental health or hold a relevant tertiary qualification within the human services sector.

How do you ensure the right support worker is matched with the participant?

We carefully match each participant with a support worker based on their individual needs, preferences, and long-term goals.

What kind of support can participants expect on their recovery journey?

Participants can expect consistent, person-centred support tailored specifically to their mental health and daily living needs.

NDIS Referral Form | Brave Minds Social Services Queensland

PARTICIPANT DETAILS

Given Name

Surname

Gender

Preferred Gender

Preferred Pronoun

Aboriginal or Torres Strait Islander descent?

YesNo

Preferred Name

Date of Birth

Preferred Contact Method

CallTextEmail

ADDRESS DETAILS

Residential Address

Postal address same as residential

Postal Address

PARTICIPANT CONTACT DETAILS

Email Address

Home Phone No.

Mobile No.

NDIS INFORMATION

NDIS Number

NDIS Start Date

NDIS End Date

FUNDING TYPE

Plan ManagedSelf-ManagedNDIA ManagedOther

ADVOCATE / REPRESENTATIVE (IF APPLICABLE)

Given Name

Surname

Relationship

Mobile Number

Email

Address Details

CULTURE, COMMUNICATION & LITERACY

Cultural/communication barriers to consider?

NoYes

EMERGENCY DETAILS (PRIMARY CONTACT)

Name

Relationship

Email

Mobile No.

SUPPORT COORDINATION DETAILS

Name

Organisation

Mobile No.

Email

SPECIALIST MEDICAL CONTACT / BEHAVIOUR SUPPORT PRACTITIONER (IF APPLICABLE)

Do you see a specialist for a medical condition/disability?

NoYes

LIVING AND SUPPORT ARRANGEMENTS

DIAGNOSIS

Primary Diagnosis

Secondary Diagnosis

At risk of homelessness?

YesNo

Support Worker gender preference?

FemaleMaleNo preference

Support Worker age preference

SUPPORT PREFERENCE TIMES

Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
MorningAfternoon	MorningAfternoon	MorningAfternoon	MorningAfternoon	MorningAfternoon	MorningAfternoon	MorningAfternoon

MEDICAL INFORMATION / HEALTH CONCERNS

SAFETY CONSIDERATIONS

NDIS PLAN GOALS

INTERESTS / HOBBIES

ADDITIONAL INFORMATION

COMPLETED BY

Name

Position

Phone

Email

Date

Participant Referral Form

PARTICIPANT DETAILS

ADDRESS DETAILS

PARTICIPANT CONTACT DETAILS

NDIS INFORMATION

FUNDING TYPE

ADVOCATE / REPRESENTATIVE (IF APPLICABLE)

CULTURE, COMMUNICATION & LITERACY

EMERGENCY DETAILS (PRIMARY CONTACT)

SUPPORT COORDINATION DETAILS

SPECIALIST MEDICAL CONTACT / BEHAVIOUR SUPPORT PRACTITIONER (IF APPLICABLE)

LIVING AND SUPPORT ARRANGEMENTS

DIAGNOSIS

SUPPORT PREFERENCE TIMES

MEDICAL INFORMATION / HEALTH CONCERNS

SAFETY CONSIDERATIONS

NDIS PLAN GOALS

INTERESTS / HOBBIES

ADDITIONAL INFORMATION

COMPLETED BY