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Unique Solutions

Adaptable Solutions

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Unique Solutions

Adaptable Solutions

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If you have a general enquiry or would just like to email us a question, we recommend you fill out our Enquiry Form here.

If you are ready to request a service, fill out the referral form below!

Request a Service

"*" indicates required fields

State*

Who is submitting this request?

Requested by*

Name*

Phone Number*

Email*

A confirmation email will be sent to this address if your request has been successfully submitted.

How did you hear about us?*

Client Details

Legal Name*

First Last

Preferred First Name (if different to legal name)

First

Date of Birth*

DD slash MM slash YYYY

Gender

Diagnosis*

Address*

Street Address Suburb State Postcode

Phone

Email

Client Details

Are you of Aboriginal or Torres Strait Islander origin?*

No

Yes Aboriginal

Yes, Torres Strait Islander

Yes, both Aboriginal and Torres Strait Islander

Will you require the assistance of a translator?*

Yes

No

If yes, please specify language required

Next of Kin Details

Next of Kin

Relationship to Client

Phone

Email

Agent Details

Name

Organisation

Phone

Email

Occupation

Project Contact

Main Contact for Project*

Your Request

How can we help?*

What are your goals/what are you hoping to achieve?

What other equipment/solutions have you previously tried?

Do you have a solution in mind? (It's okay if you don't!)

Will the project be at the Client's address?*

Yes

No

please specify project address

Additional Information

Max. file size: 128 MB.

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.

Your funding source (if known)*

NDIS

TAC

Self-funded

Other

Not applicable for this request

NDIS Clients

NDIS Client Number

Plan Start Date

DD slash MM slash YYYY

Plan End Date

DD slash MM slash YYYY

How is this plan being managed?

NDIS

Plan-managed

Self-managed

For Managed Plans we require the name of the organisation managing your plan. Please also enter the email address and phone number if you have it.

Upload your NDIS Plan

Max. file size: 128 MB.

If you have an electronic copy of your current NDIS plan, you can upload your plan here.

TAC Clients

TAC Claim Number

TAC Contact Name

TAC Contact Phone

TAC Contact Email

Funding organisation

Phone

Email

Is the client aware of this request and have they provided consent for the personal information provided on this form to be shared with Solve-TAD?*

Yes

No

Privacy Statement*

Information entered on this page is collected for the sole purpose of enabling us to provide our service. It will not be sold to a 3rd party. (Read more in our privacy policy). Please indicate your understanding of this by ticking the box.

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Please find below links to enquire about our Freedom Wheels services:

Freedom Wheels Enquiry Page

Once the forms are completed please email to solutions@tad.org.au and we’ll be in touch shortly!

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Stay in Touch

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Last name
Email*

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Solve-TAD acknowledges the traditional owners of country throughout Australia and recognises their continuing connection to land, waters and community. We pay our respects to them and their cultures and to elders past, present and emerging.

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