Honourable Support

Participant intake form

Tell us about the support you would like, how you would like it provided and what our workers need to know to support you safely and respectfully.

You can complete this form yourself, ask someone you trust to help you, or complete it together with Honourable Support. Only include information that is relevant to the support you want from us.

Before you begin

Complete it your way

You can fill this out in your own time, or someone can help you work through each section.

Only share what is relevant

Health, behaviour and personal information only needs to be included when it affects your support or worker safety.

The form adapts to you: When you select medication, personal care, transport, cleaning or another service, the relevant questions will appear automatically.

Section 1

Who are we supporting?

Basic information for contact, service delivery and invoicing.

Full legal name *

Preferred name *

NDIS participant number

Service address *

Phone

Email

Preferred contact method

Best contact days or times

Communication or accessibility needs

Person involved in decisions or contact

Complete this only if you would like another person involved.

Name

Relationship or role

Phone

Email

Who should Honourable Support contact, and about what?

Section 2

How will the service be funded?

We only need enough plan information to confirm that the requested service can be provided and invoices go to the right place.

Funding source *

How is the relevant funding managed?

Plan start date

Plan end date

Relevant support category or item

Agreed budget for our service

Funding limits or instructions relevant to our service

Plan manager

Organisation

Contact person

Phone

Invoice email or portal

Invoice approval, reference or other instructions

Optional NDIS contact

We are not providing support coordination. Complete this only if you would like us to communicate with your coordinator about our services.

Support coordinator or recovery coach

Organisation

Phone

Email

Section 3

What would you like help with?

Select every service you would like Honourable Support to provide. Detailed questions will appear later only for the services you select.

Social and community supportActivities, appointments, shopping, hobbies and community participation.

Daily living supportRoutines, prompting, practical help and building independence.

Personal careShowering, dressing, grooming, toileting or other personal assistance.

Cleaning and household tasksRegular cleaning, laundry, linen, household organisation and related tasks.

MealsMeal preparation, shopping, eating or drinking assistance.

TransportWorker vehicle, participant vehicle or public transport support.

Medication supportReminders, assistance or administration during shifts.

Mobility and transfersMobility equipment, transfers or participant-specific manual handling.

Other supportAnything not covered above.

In your own words, what would you like us to help with? *

What would good support make easier or better for them?

Is there anything they do not want a worker to do?

Section 4

When and where is support needed?

Enough information to decide whether we have a suitable worker and prepare a clear service arrangement.

Frequency *

Hours per shift *

Preferred days *

Preferred times

Acceptable alternatives

Preferred start date

Parking, entry, keys, gates or access instructions

Who is normally present during support?

How should shift confirmations or changes be communicated?

Section 5

What makes a good support relationship?

This is where we understand you as a whole human being, not just the service you need. It helps us find a worker you can genuinely feel comfortable with.

Tell us a little about yourself

What helps make a good day?

What can make a day or support shift difficult?

What has worked well or badly with previous workers?

Preferred worker personality or approach

Gender, language, cultural or other preferences

Experience or skills the worker should have

Anything that would make a worker unsuitable

Meet-and-greet preferences or questions

You can tell us when a worker does not feel like the right fit. A worker can say the same. Our job is to find an arrangement that works for both people.

Section 6

How should workers provide the support?

Practical instructions workers can follow during an ordinary shift.

How do you communicate, and how would you like workers to communicate with you?

What can they do independently, and where do they want prompting or hands-on help?

Important routines, preferences or step-by-step instructions

Privacy, dignity, cultural or household boundaries

Would you like workers to assist with money, shopping or your property?

The most important things every worker must know before the first shift

Section 7

Details for the selected services

Only the sections connected to the services selected earlier will appear.

Cleaning and household tasks

Rooms and tasks required

Who supplies products and equipment?

Allergies, sensitivities or products not to use

Priorities and expected standard

Relevant hazards or conditions in the home

Personal care

What personal care assistance is requested?

How should each task be completed and what can the participant do themselves?

Gender, privacy, equipment or other important preferences

Meals, eating and drinking

Meal preparation, shopping or eating assistance requested

Food preferences, allergies, intolerances or cultural requirements

Any swallowing or choking risk?

Current mealtime management plan?

Texture, positioning, equipment and emergency instructions

Transport and community access

Expected transport method

Usual destinations

Vehicle access, wheelchair, mobility equipment or transfer requirements

Agreed kilometres, parking, tolls or activity-cost arrangements

Any safety instructions during transport?

Medication support

Medication support requires a further check. We will need current written instructions and a suitably trained worker before medication administration can be arranged.

Level of assistance requested

Current medication instructions or plan available?

Relevant timing, storage, refusal, side-effect and escalation information

Who should be contacted about medication questions or errors?

Mobility, transfers and manual handling

Mobility equipment used

Transfers or physical assistance requested

Current transfer or manual handling plan?

Are two workers required for any task?

Falls risk, participant-specific method and what workers must not improvise

Social and community support

Activities, appointments or places the participant wants support to attend

What assistance, encouragement or boundaries are helpful in the community?

Who pays entry fees, food, tickets or other activity costs?

Daily living support

Routines, practical tasks or skills the participant wants help with

Preferred level and style of prompting

Other requested support

Describe the service and the worker instructions needed

No specialised service section is currently selected. You can continue, or return to Requested Services to change the selections.

Section 8

What does a worker need to know to keep your support safe?

This is not a full medical history. Only include health, behaviour, environmental and emergency information that affects the support we will provide.

Relevant disability, health conditions, allergies or risks

Signs that the participant is unwell, in pain, distressed or needs help

What should the worker do, and who should they contact?

Triggers, emotional regulation or behaviour support information relevant to shifts

Home or worker safety risks

Would missing a shift create a serious risk? What backup arrangement exists?

Emergency contacts

Primary emergency contact *

Relationship

Phone *

Secondary contact and phone

Emergency instructions relevant to our service

Current plans or instructions to obtain

Medication instructions or plan Mealtime management plan Transfer or manual handling plan Behaviour or crisis plan Communication profile Other participant-specific instructions

Document notes

Section 9

Your consent

Please confirm how Honourable Support may use the information in this form.

Completion

Review the participant intake

Check the information, correct anything missing and then save it to Google Drive or download a local backup.

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