Request a Service

To request assistance please enter your information into the form below. Alternatively, you can download a copy of the Project Request Form and fax or send it in to Solve Disability Solutions Central Office. 

Note: If you are an agent requesting a service on behalf of the client, please make sure the client and/or their carers are informed of the project. They will be receiving information from us in the mail, and it can be confusing if they are not aware of the request.

  1. Client Details

  2. Name*
    Please enter clients name
  3. Address*
    Please enter clients address
  4. Suburb*
    Please enter clients suburb
  5. Postcode*
    Please enter clients postcode
  6. Phone Number
    Please enter clients phone number
  7. Mobile Phone Number
    Invalid Input
  8. Email Address
    Please enter email address
  9. Date of Birth*
    Please enter date of birth
  10. Diagnosis*
    Please enter diagnosis
  11. Next of Kin Details

  12. Next of Kin
    Invalid Input
  13. Relationship to Client
    Invalid Input
  14. Phone Number
    Please enter clients phone number
  15. Email Address
    Please enter email address
  16. Agent Details

  17. Name
    Please enter clients name
  18. Address
    Please enter clients address
  19. Phone Number
    Please enter clients phone number
  20. Email Address
    Please enter email address
  21. Occupation
    Please enter email address
  22. Project Contact

  23. Main contact for the project*
    Invalid Input
  24. Who is submitting this request?

  25. Requested By*
    Invalid Input
  26. Email Address*
    Please enter email address
    A confirmation email will be sent to this address if your request has been successfully submitted.
  27. If you have selected 'other', please provide the following additional contact details.
  28. Name
    Please enter the requester name
  29. Phone Number
    Please enter the requesters phone number
  30. Your Request

  31. Request Details*
    Please enter details of your request
  32. Is project at client's address?*

    Please make a selection
  33. If no, project address is
  34. Is the client aware of this request?*

    Please make a selection
  35. Additional documentation
    Invalid Input
    If you have any additional documentation you would like to include with this request, such as a photo or file, you can upload it here.
  36. NDIS Clients

  37. NDIS Client Number
    Please enter email address
  38. Plan Start Date
  39. Plan End Date
  40. Is this service in your plan?

    Please make a selection
  41. How is this plan being managed?


    Please make a selection
  42. For Managed Plans we require the name of the Plan Manager
    Please enter diagnosis
  43. Upload your NDIS plan
    Invalid Input
    If you have an electronic copy of your current NDIS plan, you can upload your plan here.
  44. TAC Clients

  45. TAC Claim Number
    Please enter email address
  46. TAC Contact Name
    Please enter email address
  47. TAC Contact Phone
    Please enter email address
  48. TAC Contact Email
    Please enter email address
  49. Payment Details

  50. If this project is not being covered by NDIS or TAC, who will be paying for the project?
  51. Payment by client?

    Please make a selection
  52. If no, payment by
  53. Organisation
  54. Address
  55. Phone Number
  56. Email Address
  57. Privacy Statement*
    Please indicate your understanding of this privacy statement by ticking the box!
  58. Tick the box