Alixa

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Make Referral
  • Start & UploadWho's referring and NDIS plan
  • ParticipantPersonal details
  • FundingNDIS plan & budgets
  • ReferrerYour details
  • ServicesWhat's needed
  • ClinicalHealth & safety
  • ConsentPermissions & signature
  • ReviewFinal check & submit

Start Your Referral

Who is making this referral?
Upload NDIS Plan

Drop NDIS plan here or click to upload

Supports PDF, DOCX, JPG, PNG files
AI-powered auto-prefill

Our system will analyze your NDIS plan and automatically populate participant details, funding information, goals, and support categories to save you time.

Participant Details

Personal Information
Address
Contact Information

Funding

NDIS Plan Management
Plan Dates
Budget Information (Optional)
Capacity Building
Core Supports
Capital Supports
Participant Goals

    Referrer Information

    Your contact information will be used to communicate about this referral and coordinate care. We follow Australian privacy standards and will not share your information without consent.

    Services Requested

    Reason for Referral *
    Service Delivery Mode *
    Availability & Preferences

    Clinical & Safety Information

    Safety Considerations
    Diagnoses & Medical History
      Current Medications
      Supporting Reports

      Drop files here or click to upload

      PDF, Word documents, and images up to 10MB each

      Consent & Privacy

      Consent Authority
      Privacy & Consent Statement
      • I have the authority to provide this referral and consent on behalf of the participant.
      • I consent to Alixa collecting, using, and disclosing the information provided for the purpose of care coordination and service delivery.
      • I understand that information will be shared with relevant allied health professionals to provide appropriate care.
      • I have read and agree to the Privacy Policy and Terms of Service.
      • All information provided is accurate and complete to the best of my knowledge.
      Digital Signature
      Legal Notice: By providing your digital signature, you acknowledge that this constitutes a legally binding electronic signature equivalent to a handwritten signature.

      Review Your Referral

      Please review all information before submitting. You can edit any section by clicking the edit button.

      Participant Details
      NDIS Plan & Funding
      Referrer Information
      Services Requested
      Clinical Information
      Consent & Signature
      What happens next?
      • You’ll receive a confirmation email with your reference number
      • Our intake team will review your referral within 1-2 business days
      • We’ll contact you to confirm details and arrange initial appointments
      • Participants will be matched with appropriate clinicians

      Alixa

      Making allied health accessible through professional telehealth services.

      • Quick Links
      • About Us
      • Our Services
      • How It Works
      • Make Referral
      • Services
      • Occupational Therapy
      • Speech Therapy
      • Positive Behaviour Support
      • NDIS Telehealth
      • Contact
      • 1300 ALIXA (254 942)
      • hello@alixa.com.au
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