Let’s get started.Please fill out the following information to get started with one of our amazing support workers. Client * First Name Last Name Date of birth * MM DD YYYY Gender * Pronouns * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone (###) ### #### Primary Contact for client, if different to the client. * Please list first and last name, phone number, email address and relation to client. Secondary Contact for client Please list first and last name, phone number and relation to client. Emergency Contact for client * Please list first and last name, phone number and relation to client. *must be different to the primary/secondary contact* NDIS plan * Plan managed Self managed What email address should we send invoices to? * Please list any NDIS goals or personal goals you would like support workers to assist with: * Please list any diagnosis information: * Please list any allergies or medical conditions that Hive should be aware of: * Please list any transport requirements * Eg does the client require a tethered car seat, a booster seat, can they use a normal seatbelt in the back seat, are they able to ride in the front seat? Please answer even if transport may not be required. Living circumstances * Please list any information regarding multiple living addresses, any court orders etc, if any. Let us know more about the client! * Please list any special interests, hobbies, skills, strengths, weaknesses or triggers that would be helpful for your support workers to know. Let us know what you are hoping to get out of support work sessions: * Some people know exactly what kind of support they require. For others, especially if this is the first time you are engaging in supports, it can be overwhelming. We can help you decide what to get out of your sessions if you aren't sure. What services are you interested in? * Please list all, even if you aren't needing to utilize all straight away. Self care Transport Respite Getting ready for/ getting to school Getting home from school/ after school routine Regulating behaviours and emotions Getting out into the community, social skills Life skills, eg time management, using public transport, setting routines etc. Chaperoning to events Other Please list preferred days/ times * Please list any days or times you require. If the days/ times you require are not available straight away, we will add you to our waitlist and you will be allocated the day/ time when it becomes available. How many hours do you require per week? * If you aren't sure, please just let us know and we can help you work this out. How did you hear about us? * Please list any other information you would like us to know: * Some important information we would like you to know before we get started: * Please tick that you have read each point. You will have the opportunity to discuss any of these points, as well as any of the other information in this form once we get back to you. Minimum shift times are 2 hours. This is to enable us to comply with the minimum shift times for our employees, under their award. Shifts that require less than 2 hours of support (eg transport) will be billed at a minimum of 2 hours. We aim to orientate a minimum of 2 workers per family. This ensures continuity if one workers is unavailable etc. If you wish to add any other contact person to the clients file, to make changes to bookings, enquire about services etc you will need to let us know. Once we are ready to make some bookings, we will send you a service agreement to sign. This includes all of our rates, policies (eg cancellations) and other important information. If you want this info earlier, please let us know and we can email you a blank service agreement. We send SMS reminders the day before all shifts While most bookings are regular, weekly days and times, we encourage all families to email, text or call any time they wish to book extra sessions, no matter how last minute these requests are. We actively encourage feedback from families regarding any part of our service. We understand that some workers will not always be the right fit for some families, and we encourage families to give us this feedback so we can find the right fit! Thank you!
