Free template · intake
Intake form template for a new participant's first conversation.
Everything the Practice Standards expect you to learn and explain when someone starts with you: what they want and why, how their plan is managed, who they'd like supporting them, what matters to them, what an emergency would need, and consent — in one conversation, written down once, ready for the service agreement, the support plan and the risk assessment.
Who it is for: NDIS providers and support coordinators taking on a new participant, filled in together with the participant or their representative.
No email, no sign-up. Checked against the rules on 22 October 2026.
What's in it
10 sections, built on the rules.
- 01About the participantFull name, and the name they like to be called · Date of birth and NDIS number · Address · Phone and email · How they'd like us to contact them · Language, interpreter and the way they communicate best
- 02Representative and support networkRepresentative, if any: name, relationship and authority · People they'd like involved
- 03Their plan and fundingPlan start and end dates · How the plan is managed · Plan manager or support coordinator, if any: name and contact · Supports they're asking us for
- 04What they want from usTheir goals, in their words · What's working well, and their strengths · How they like things done
- 05Culture, values and beliefsCulture, faith or values that shape how they'd like to be supported
- 06Who supports themTheir preferences about workers
- 07Health and daily livingHealth needs that affect their supports · Health checks they'd like support with · Other providers and health professionals · If a support were missed or late
- 08EmergenciesEmergency contacts · What they'd need in an emergency or a disaster
- 09Consent and choicesConsent to collect and share their information recorded on (date) · Told they can take time to decide, and ask someone they trust (date) · Advocate or support person present, if they wanted one
- 10Next stepsTo prepare with them · Intake completed by: name, role, date · Participant or representative: name, signature, date · Copy given to the participant (date and format)
Explain what you offer, in a way they understand
The supports you offer, any conditions on getting them and what they cost are written down, and explained to each participant in the language, way of communicating and terms they're most likely to understand.
NDIS (Quality Indicators for NDIS Practice Standards) Guidelines 2018, section 19(1) — legislation.gov.auPlan around their needs, goals and strengths
Assessment and planning reflect the participant's needs, preferences, strengths and goals, worked out with them — and, with their consent, with their support network.
NDIS (Quality Indicators for NDIS Practice Standards) Guidelines 2018, section 20(1) — legislation.gov.auRisk includes what a missed support would mean
Risk assessments consider how much the participant relies on the provider and what a disruption to their supports would mean for their health and safety; support plans and service agreements cover emergencies and disasters.
NDIS (Quality Indicators for NDIS Practice Standards) Guidelines 2018, sections 20(2A), 20(9) and 21(5) — legislation.gov.auThey have a say in who supports them
Providers make reasonable efforts to involve each participant in choosing their workers, including the gender of workers who give personal care, and, with their consent, work with their other providers, health care and allied health included.
NDIS (Quality Indicators for NDIS Practice Standards) Guidelines 2018, section 22(2)–(3) — legislation.gov.auTheir culture, values and beliefs shape the support
At the participant's direction, their culture, values and beliefs are identified and respected, and they're supported to stay connected with the people and community they choose.
NDIS (Quality Indicators for NDIS Practice Standards) Guidelines 2018, sections 6(3) and 7 — legislation.gov.auConsent to what's collected, and why
Each participant understands and agrees to what personal information is collected and why, recordings included.
NDIS (Quality Indicators for NDIS Practice Standards) Guidelines 2018, section 8(3) — legislation.gov.auTime to decide, and an advocate if they want one
Participants have enough time to consider their options and seek advice at every stage, assessment and planning included, and can have an advocate of their choosing — present, if they wish.
NDIS (Quality Indicators for NDIS Practice Standards) Guidelines 2018, section 9(4)–(5) — legislation.gov.auThe template
Use it here, or take it with you.
Print it, save it as a PDF, or download the Word file and put your own name and logo on it.
New participant intake
Organisation: ______________________________
01 About the participant
Full name, and the name they like to be called
Date of birth and NDIS number
Address
Phone and email
How they'd like us to contact them
- Phone call
- Text message
- Through their representative
Language, interpreter and the way they communicate bestFor example: Easy Read, an interpreter for a named language, extra time, a communication device.
02 Representative and support network
Involve family, carers and others only as far as the participant wants.
Representative, if any: name, relationship and authorityA plan nominee, a guardian, the parent of a child.
People they'd like involved
| Name | Relationship | Phone or email | Involve in what |
|---|---|---|---|
03 Their plan and funding
Plan start and end dates
How the plan is managed
- NDIA-managed
- Plan-managed
- Self-managed
- A mix
Plan manager or support coordinator, if any: name and contact
Supports they're asking us for
| Support | How often | When | Support item, if known |
|---|---|---|---|
04 What they want from us
Their goals, in their words
What's working well, and their strengths
How they like things doneRoutines, times of day, what matters to them, what they'd rather we didn't do.
05 Culture, values and beliefs
Culture, faith or values that shape how they'd like to be supported
06 Who supports them
Their preferences about workersFor example: the gender of workers who give personal care, a language, someone they already know.
07 Health and daily living
Health needs that affect their supportsConditions, medications, allergies — what a worker needs to know.
Health checks they'd like support withVaccinations, dental check-ups, a comprehensive health assessment, allied health.
Other providers and health professionals
| Name | Role | Phone or email | Agreed to share information (yes or no) |
|---|---|---|---|
If a support were missed or lateHow much they rely on us, and what it would mean for their health and safety — this goes into the risk assessment.
08 Emergencies
Emergency contacts
| Name | Relationship | Phone |
|---|---|---|
What they'd need in an emergency or a disasterPower for equipment, medication, getting out of the house, who checks on them.
09 Consent and choices
Consent to collect and share their information recorded on (date)On the consent form, recordings agreed separately.
Told they can take time to decide, and ask someone they trust (date)
Advocate or support person present, if they wanted one
10 Next steps
To prepare with them
- Service agreement
- Support plan
- Risk assessment
- Consent form
Intake completed by: name, role, date
Participant or representative: name, signature, date
Copy given to the participant (date and format)
A free template to adapt — not an official form, and not legal or compliance advice. Corella is not affiliated with the NDIA or the NDIS Quality and Safeguards Commission. The rules behind it change, so check the current guidance and your own obligations before you rely on it. A free template from Corella — corellacare.com.au/templates/ndis-intake-form/
Filling it in
What makes it a good record.
Ask once, write it down once
What you learn at intake becomes the service agreement, the support plan and the risk assessment. Carry it across, so the participant isn't asked the same questions three times.
Goals in their words
Write goals the way the participant says them. "Catch the bus to the library on my own" plans better than "community access".
Costs and conditions first
Say what you offer, what it costs and how you'll be paid before anything is signed. How the plan is managed decides how you're paid.
The right people in the room
Offer an interpreter, an advocate or a support person before the meeting, not during it, and give the participant time to decide.
A start, not a gate
An intake is the first conversation. Look at it again when the support plan is reviewed, and whenever their needs or plan change.
A free template to adapt — not an official form, and not legal or compliance advice. Corella is not affiliated with the NDIA or the NDIS Quality and Safeguards Commission. The rules behind it change, so check the current guidance and your own obligations before you rely on it.
In Corella
The same record, kept for you.
In Corella, a referral from your website lands in the Intake queue, an intake can be filled in on a phone or tablet — kept on the device without signal and sent when it returns — and the intake summary renders as a PDF from the record, with your logo.
Fair questions
Before you use it.
Sources
Is there an official NDIS intake form for providers?
What should an NDIS intake form include?
Who fills it in?
Why ask how the plan is managed?
How does intake connect to the other templates?
Keep this record in one system.
See how Corella keeps the same record on the shift it belongs to — book a walkthrough, or try a live demo with a time-boxed pass.