Contact Us

Please complete the below intake form and our Intake Officer will be in contact with you in the next 2-3 business days. Please note that submitting this form does not guarantee that we can provide support for your issue. If your enquiry is urgent, please call 1800 250 292.

Intake Form

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Does the enquiry relate to yourself or another person?

• Self
• Another person

Have you received consent from the client being referred to contact us and provide their details?

• Yes
• No

Full name of the person the enquiry relates to *

First

Last

Residential address

Address Line 1

City

State / Province / Region

Postal Code

Layout

Phone *

Email

Layout

Preferred method of contact

• Phone
• Text
• Email

Date of birth

Gender

Does the person this enquiry relates to have a disability?

• Yes
• No

What is the disability?

Please provide a summary of your Advocacy issue

Do you have any disability specific requirements in relation to how you wish to engage with us?

Do you require an interpreter?

• Yes
• No

What is the primary spoken language?

How did you find out about RDAS?

• Previous client
• Referral
• Online search
• Other

What agency/organisation referred you to us?

Please specify

Do you have a nominated representative to act on your behalf?

• Yes
• No

What is your representative’s name, agency/relationship/phone/email?

Do you give consent for your representative to act on your behalf?

• Yes
• No

Are there any important dates we need to be aware of in relation to this support request?

• Yes
• No

What are these?

Submit