Make a Referral

Start the Journey

Begin your journey to A Greater You.

All journeys begin with a single step. Forge a new path forward with support from Butter Fish Services®. Fill out the referral form below and a member of our friendly team will be in touch to arrange a consultation.

If you have general questions about our services or funding options, call us on 1300 020 271 or email admin@butterfish.com.au.

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Fields marked * are required.

Step 1 of 10 About the referral

I am referring

Requesting support for

Funding source

How did you hear about us?

If other, please specify

Step 2 of 10 Referrer details

The person authorised to schedule appointments.

Relationship to referee

Organisation

First name

Last name

Phone number

Preferred contact method

Step 3 of 10 NDIS plan details

NDIS number

Start date of plan

End date of plan

Available funding

Funding management

Name of plan manager

Plan invoice number

Plan manager contact email

Upload of NDIS plan PDF, Word document or image, up to 10 MB.

By uploading a copy of your or your referee’s NDIS Plan, you consent to Butter Fish Services® using this information to arrange care and therapeutic services as set out in our Privacy Statement. If you would rather discuss your needs without uploading a plan, please contact us — though without these details we may not be able to supply the services you request.

Step 4 of 10 Medicare details

Medicare card number

IRN reference

Valid to date

Step 5 of 10 Health insurance details

Health insurance provider

Health insurer ABN

Membership card number

IRN number

Customer reference number If applicable.

Policy start date

Step 7 of 10 Behaviour support & therapy

Type of behaviour therapy service

Do you require a behaviour support plan?

Type of behaviour support plan

Do restrictive practices apply?

Which restrictive practices apply? Seclusion Physical Mechanical Chemical Environment Other

If other, please specify

Step 8 of 10 Assessment

Type of assessment Select all that apply. Cognitive Assessment (e.g. IQ Testing) Developmental Assessment (e.g. Memory) Educational Assessment (e.g. Learning Difficulty) Behaviour Assessment (e.g. ADHD, ADD) Autism Spectrum Disorder Assessment

Type of behaviour assessment

Step 9 of 10 Psychology services

Desired frequency of psychology service

If other, please specify

Step 10 of 10 Delivery & consent

Preferred delivery of services