Make A Referral - Southern Star Care

Southern Star Care Intake Form

Please fill our the form below, and a member of our team will contact you!

Date

Full Name*

NDIS Number*

Date of Birth*

Address*

Gender*

Photo Upload* Please upload a clear, unedited and recent photo of the participant, so we can use this for their profile and person-centred plan. This photo should capture them from their torso and above

Contact Name*

Contact Number*

Email Address*

Disability Diagnosis*

Service Inquiry*

Behaviours/Triggers/Dislikes*

Does the Participant have a Support Coordinator?*

Plan Management*

NDIS Plan Upload* Or screenshot of funding/budget

Allied Health Document Upload** Please include relevant Allied Health Reports (Physio, Speech, OT)

Are there any Behaviours of Concern?*

Referrer Full Name

Referrer Contact Number

Referrer Email

Referrer Company Name

Service Commencement

Testimonials

Get In Touch

Get in touch by filling out the Contact Us form below

mail

admin@southernstarcare.com.au

call

location

Suite 20, 799 Springvale Road, Mulgrave

Copyright © 2025 | Southern Star Care | All Rights Reserved

img:is([sizes="auto" i],[sizes^="auto," i]){contain-intrinsic-size:3000px 1500px;}img.wp-smiley,img.emoji{display:inline !important;border:none !important;box-shadow:none !important;height:1em !important;width:1em !important;margin:0 .07em !important;vertical-align:-.1em !important;background:none !important;padding:0 !important;}.wp-block-button__link{color:#fff;background-color:#32373c;border-radius:9999px;box-shadow:none;text-decoration:none;padding:calc(.667em + 2px) calc(1.333em + 2px);font-size:1.125em;}.wp-block-file__button{background:#32373c;color:#fff;text-decoration:none;}:root{--wp--preset--aspect-ratio--square:1;--wp--preset--aspect-ratio--4-3:4/3;--wp--preset--aspect-ratio--3-4:3/4;--wp--preset--aspect-ratio--3-2:3/2;--wp--preset--aspect-ratio--2-3:2/3;--wp--preset--aspect-ratio--16-9:16/9;--wp--preset--aspect-ratio--9-16:9/16;--wp--preset--color--black:#000;--wp--preset--color--cyan-bluish-gray:#abb8c3;--wp--preset--color--white:#fff;--wp--preset--color--pale-pink:#f78da7;--wp--preset--color--vivid-red:#cf2e2e;--wp--preset--color--luminous-vivid-orange:#ff6900;--wp--preset--color--luminous-vivid-amber:#fcb900;--wp--preset--color--light-green-cyan:#7bdcb5;--wp--preset--color--vivid-green-cyan:#00d084;--wp--preset--color--pale-cyan-blue:#8ed1fc;--wp--preset--color--vivid-cyan-blue:#0693e3;--wp--preset--color--vivid-purple:#9b51e0;--wp--preset--color--accent:#cd2653;--wp--preset--color--primary:#000;--wp--preset--color--secondary:#6d6d6d;--wp--preset--color--subtle-background:#dcd7ca;--wp--preset--color--background:#f5efe0;--wp--preset--gradient--vivid-cyan-blue-to-vivid-purple:linear-gradient(135deg,rgba(6,147,227,1) 0%,#9b51e0 100%);--wp--preset--gradient--light-green-cyan-to-vivid-green-cyan:linear-gradient(135deg,#7adcb4 0%,#00d082 100%);--wp--preset--gradient--luminous-vivid-amber-to-luminous-vivid-orange:linear-gradient(135deg,rgba(252,185,0,1) 0%,rgba(255,105,0,1) 100%);--wp--preset--gradient--luminous-vivid-orange-to-vivid-red:linear-gradient(135deg,rgba(255,105,0,1) 0%,#cf2e2e 100%);--wp--preset--gradient--very-light-gray-to-cyan-bluish-gray:linear-gradient(135deg,#eee 0%,#a9b8c3 100%);--wp--preset--gradient--cool-to-warm-spectrum:linear-gradient(135deg,#4aeadc 0%,#9778d1 20%,#cf2aba 40%,#ee2c82 60%,#fb6962 80%,#fef84c 100%);--wp--preset--gradient--blush-light-purple:linear-gradient(135deg,#ffceec 0%,#9896f0 100%);--wp--preset--gradient--blush-bordeaux:linear-gradient(135deg,#fecda5 0%,#fe2d2d 50%,#6b003e 100%);--wp--preset--gradient--luminous-dusk:linear-gradient(135deg,#ffcb70 0%,#c751c0 50%,#4158d0 100%);--wp--preset--gradient--pale-ocean:linear-gradient(135deg,#fff5cb 0%,#b6e3d4 50%,#33a7b5 100%);--wp--preset--gradient--electric-grass:linear-gradient(135deg,#caf880 0%,#71ce7e 100%);--wp--preset--gradient--midnight:linear-gradient(135deg,#020381 0%,#2874fc 100%);--wp--preset--font-size--small:18px;--wp--preset--font-size--medium:20px;--wp--preset--font-size--large:26.25px;--wp--preset--font-size--x-large:42px;--wp--preset--font-size--normal:21px;--wp--preset--font-size--larger:32px;--wp--preset--spacing--20:.44rem;--wp--preset--spacing--30:.67rem;--wp--preset--spacing--40:1rem;--wp--preset--spacing--50:1.5rem;--wp--preset--spacing--60:2.25rem;--wp--preset--spacing--70:3.38rem;--wp--preset--spacing--80:5.06rem;--wp--preset--shadow--natural:6px 6px 9px rgba(0,0,0,.2);--wp--preset--shadow--deep:12px 12px 50px rgba(0,0,0,.4);--wp--preset--shadow--sharp:6px 6px 0px rgba(0,0,0,.2);--wp--preset--shadow--outlined:6px 6px 0px -3px rgba(255,255,255,1),6px 6px rgba(0,0,0,1);--wp--preset--shadow--crisp:6px 6px 0px rgba(0,0,0,1);}:where(.is-layout-flex){gap:.5em;}:where(.is-layout-grid){gap:.5em;}body .is-layout-flex{display:flex;}.is-layout-flex{flex-wrap:wrap;align-items:center;}.is-layout-flex > :is(*,div){margin:0;}body .is-layout-grid{display:grid;}.is-layout-grid > :is(*,div){margin:0;}:where(.wp-block-columns.is-layout-flex){gap:2em;}:where(.wp-block-columns.is-layout-grid){gap:2em;}:where(.wp-block-post-template.is-layout-flex){gap:1.25em;}:where(.wp-block-post-template.is-layout-grid){gap:1.25em;}.has-black-color{color:var(--wp--preset--color--black) !important;}.has-cyan-bluish-gray-color{color:var(--wp--preset--color--cyan-bluish-gray) !important;}.has-white-color{color:var(--wp--preset--color--white) !important;}.has-pale-pink-color{color:var(--wp--preset--color--pale-pink) !important;}.has-vivid-red-color{color:var(--wp--preset--color--vivid-red) !important;}.has-luminous-vivid-orange-color{color:var(--wp--preset--color--luminous-vivid-orange) !important;}.has-luminous-vivid-amber-color{color:var(--wp--preset--color--luminous-vivid-amber) !important;}.has-light-green-cyan-color{color:var(--wp--preset--color--light-green-cyan) !important;}.has-vivid-green-cyan-color{color:var(--wp--preset--color--vivid-green-cyan) !important;}.has-pale-cyan-blue-color{color:var(--wp--preset--color--pale-cyan-blue) !important;}.has-vivid-cyan-blue-color{color:var(--wp--preset--color--vivid-cyan-blue) !important;}.has-vivid-purple-color{color:var(--wp--preset--color--vivid-purple) !important;}.has-black-background-color{background-color:var(--wp--preset--color--black) !important;}.has-cyan-bluish-gray-background-color{background-color:var(--wp--preset--color--cyan-bluish-gray) !important;}.has-white-background-color{background-color:var(--wp--preset--color--white) !important;}.has-pale-pink-background-color{background-color:var(--wp--preset--color--pale-pink) !important;}.has-vivid-red-background-color{background-color:var(--wp--preset--color--vivid-red) !important;}.has-luminous-vivid-orange-background-color{background-color:var(--wp--preset--color--luminous-vivid-orange) !important;}.has-luminous-vivid-amber-background-color{background-color:var(--wp--preset--color--luminous-vivid-amber) !important;}.has-light-green-cyan-background-color{background-color:var(--wp--preset--color--light-green-cyan) !important;}.has-vivid-green-cyan-background-color{background-color:var(--wp--preset--color--vivid-green-cyan) !important;}.has-pale-cyan-blue-background-color{background-color:var(--wp--preset--color--pale-cyan-blue) !important;}.has-vivid-cyan-blue-background-color{background-color:var(--wp--preset--color--vivid-cyan-blue) !important;}.has-vivid-purple-background-color{background-color:var(--wp--preset--color--vivid-purple) !important;}.has-black-border-color{border-color:var(--wp--preset--color--black) !important;}.has-cyan-bluish-gray-border-color{border-color:var(--wp--preset--color--cyan-bluish-gray) !important;}.has-white-border-color{border-color:var(--wp--preset--color--white) !important;}.has-pale-pink-border-color{border-color:var(--wp--preset--color--pale-pink) !important;}.has-vivid-red-border-color{border-color:var(--wp--preset--color--vivid-red) !important;}.has-luminous-vivid-orange-border-color{border-color:var(--wp--preset--color--luminous-vivid-orange) !important;}.has-luminous-vivid-amber-border-color{border-color:var(--wp--preset--color--luminous-vivid-amber) !important;}.has-light-green-cyan-border-color{border-color:var(--wp--preset--color--light-green-cyan) !important;}.has-vivid-green-cyan-border-color{border-color:var(--wp--preset--color--vivid-green-cyan) !important;}.has-pale-cyan-blue-border-color{border-color:var(--wp--preset--color--pale-cyan-blue) !important;}.has-vivid-cyan-blue-border-color{border-color:var(--wp--preset--color--vivid-cyan-blue) !important;}.has-vivid-purple-border-color{border-color:var(--wp--preset--color--vivid-purple) !important;}.has-vivid-cyan-blue-to-vivid-purple-gradient-background{background:var(--wp--preset--gradient--vivid-cyan-blue-to-vivid-purple) !important;}.has-light-green-cyan-to-vivid-green-cyan-gradient-background{background:var(--wp--preset--gradient--light-green-cyan-to-vivid-green-cyan) !important;}.has-luminous-vivid-amber-to-luminous-vivid-orange-gradient-background{background:var(--wp--preset--gradient--luminous-vivid-amber-to-luminous-vivid-orange) !important;}.has-luminous-vivid-orange-to-vivid-red-gradient-background{background:var(--wp--preset--gradient--luminous-vivid-orange-to-vivid-red) !important;}.has-very-light-gray-to-cyan-bluish-gray-gradient-background{background:var(--wp--preset--gradient--very-light-gray-to-cyan-bluish-gray) !important;}.has-cool-to-warm-spectrum-gradient-background{background:var(--wp--preset--gradient--cool-to-warm-spectrum) !important;}.has-blush-light-purple-gradient-background{background:var(--wp--preset--gradient--blush-light-purple) !important;}.has-blush-bordeaux-gradient-background{background:var(--wp--preset--gradient--blush-bordeaux) !important;}.has-luminous-dusk-gradient-background{background:var(--wp--preset--gradient--luminous-dusk) !important;}.has-pale-ocean-gradient-background{background:var(--wp--preset--gradient--pale-ocean) !important;}.has-electric-grass-gradient-background{background:var(--wp--preset--gradient--electric-grass) !important;}.has-midnight-gradient-background{background:var(--wp--preset--gradient--midnight) !important;}.has-small-font-size{font-size:var(--wp--preset--font-size--small) !important;}.has-medium-font-size{font-size:var(--wp--preset--font-size--medium) !important;}.has-large-font-size{font-size:var(--wp--preset--font-size--large) !important;}.has-x-large-font-size{font-size:var(--wp--preset--font-size--x-large) !important;}:where(.wp-block-post-template.is-layout-flex){gap:1.25em;}:where(.wp-block-post-template.is-layout-grid){gap:1.25em;}:where(.wp-block-columns.is-layout-flex){gap:2em;}:where(.wp-block-columns.is-layout-grid){gap:2em;}:root :where(.wp-block-pullquote){font-size:1.5em;line-height:1.6;}@media only screen and ( max-width: 992px ){html body div.wprm-wrapper{overflow:scroll;}#mg-wprm-wrap ul li{border-top:solid 1px rgba(255,255,255,.05);border-bottom:solid 1px rgba(255,255,255,.05);}#wprmenu_bar{background-image:url("");background-size:cover;background-repeat:repeat;}#wprmenu_bar.nitro-lazy{background-image:none !important;}#wprmenu_bar{background-color:#000;}html body div#mg-wprm-wrap .wpr_submit .icon.icon-search{color:#fff;}#wprmenu_bar .menu_title,#wprmenu_bar .wprmenu_icon_menu,#wprmenu_bar .menu_title a{color:#fff;}#wprmenu_bar .menu_title a{font-size:20px;font-weight:normal;}#mg-wprm-wrap li.menu-item a{font-size:15px;text-transform:uppercase;font-weight:normal;}#mg-wprm-wrap li.menu-item-has-children ul.sub-menu a{font-size:15px;text-transform:uppercase;font-weight:normal;}#mg-wprm-wrap li.current-menu-item > a{background:#000;}#mg-wprm-wrap li.current-menu-item > a,#mg-wprm-wrap li.current-menu-item span.wprmenu_icon{color:#fff !important;}#mg-wprm-wrap{background-color:#5bb4e4;}.cbp-spmenu-push-toright,.cbp-spmenu-push-toright .mm-slideout{left:80%;}.cbp-spmenu-push-toleft{left:-80%;}#mg-wprm-wrap.cbp-spmenu-right,#mg-wprm-wrap.cbp-spmenu-left,#mg-wprm-wrap.cbp-spmenu-right.custom,#mg-wprm-wrap.cbp-spmenu-left.custom,.cbp-spmenu-vertical{width:80%;max-width:400px;}#mg-wprm-wrap ul#wprmenu_menu_ul li.menu-item a,div#mg-wprm-wrap ul li span.wprmenu_icon{color:#fff;}#mg-wprm-wrap ul#wprmenu_menu_ul li.menu-item:valid ~ a{color:#fff;}#mg-wprm-wrap ul#wprmenu_menu_ul li.menu-item a:hover{background:#000;color:#fff !important;}div#mg-wprm-wrap ul>li:hover>span.wprmenu_icon{color:#fff !important;}.wprmenu_bar .hamburger-inner,.wprmenu_bar .hamburger-inner::before,.wprmenu_bar .hamburger-inner::after{background:#fff;}.wprmenu_bar .hamburger:hover .hamburger-inner,.wprmenu_bar .hamburger:hover .hamburger-inner::before,.wprmenu_bar .hamburger:hover .hamburger-inner::after{background:#fff;}#wprmenu_menu.left{width:80%;left:-80%;right:auto;}#wprmenu_menu.right{width:80%;right:-80%;left:auto;}.wprmenu_bar .hamburger{float:right;}.wprmenu_bar #custom_menu_icon.hamburger{top:px;right:0px;float:right;background-color:#ccc;}html body div#wprmenu_bar{padding-top:16.5px;padding-bottom:16.5px;}.wprmenu_bar div.wpr_search form{top:46.5px;}html body div#wprmenu_bar{height:60px;}#mg-wprm-wrap.cbp-spmenu-left,#mg-wprm-wrap.cbp-spmenu-right,#mg-widgetmenu-wrap.cbp-spmenu-widget-left,#mg-widgetmenu-wrap.cbp-spmenu-widget-right{top:60px !important;}#navbarNavDropdown,.navbar-toggler,header{display:none !important;}.wpr_custom_menu #custom_menu_icon{display:block;}html{padding-top:42px !important;}#wprmenu_bar,#mg-wprm-wrap{display:block;}div#wpadminbar{position:fixed;}}.color-accent,.color-accent-hover:hover,.color-accent-hover:focus,:root .has-accent-color,.has-drop-cap:not(:focus):first-letter,.wp-block-button.is-style-outline,a{color:#cd2653;}blockquote,.border-color-accent,.border-color-accent-hover:hover,.border-color-accent-hover:focus{border-color:#cd2653;}button,.button,.faux-button,.wp-block-button__link,.wp-block-file .wp-block-file__button,input[type="button"],input[type="reset"],input[type="submit"],.bg-accent,.bg-accent-hover:hover,.bg-accent-hover:focus,:root .has-accent-background-color,.comment-reply-link{background-color:#cd2653;}.fill-children-accent,.fill-children-accent *{fill:#cd2653;}body,.entry-title a,:root .has-primary-color{color:#000;}:root .has-primary-background-color{background-color:#000;}cite,figcaption,.wp-caption-text,.post-meta,.entry-content .wp-block-archives li,.entry-content .wp-block-categories li,.entry-content .wp-block-latest-posts li,.wp-block-latest-comments__comment-date,.wp-block-latest-posts__post-date,.wp-block-embed figcaption,.wp-block-image figcaption,.wp-block-pullquote cite,.comment-metadata,.comment-respond .comment-notes,.comment-respond .logged-in-as,.pagination .dots,.entry-content hr:not(.has-background),hr.styled-separator,:root .has-secondary-color{color:#6d6d6d;}:root .has-secondary-background-color{background-color:#6d6d6d;}pre,fieldset,input,textarea,table,table *,hr{border-color:#dcd7ca;}caption,code,code,kbd,samp,.wp-block-table.is-style-stripes tbody tr:nth-child(odd),:root .has-subtle-background-background-color{background-color:#dcd7ca;}.wp-block-table.is-style-stripes{border-bottom-color:#dcd7ca;}.wp-block-latest-posts.is-grid li{border-top-color:#dcd7ca;}:root .has-subtle-background-color{color:#dcd7ca;}body:not(.overlay-header) .primary-menu > li > a,body:not(.overlay-header) .primary-menu > li > .icon,.modal-menu a,.footer-menu a,.footer-widgets a:where(:not(.wp-block-button__link)),#site-footer .wp-block-button.is-style-outline,.wp-block-pullquote:before,.singular:not(.overlay-header) .entry-header a,.archive-header a,.header-footer-group .color-accent,.header-footer-group .color-accent-hover:hover{color:#cd2653;}.social-icons a,#site-footer button:not(.toggle),#site-footer .button,#site-footer .faux-button,#site-footer .wp-block-button__link,#site-footer .wp-block-file__button,#site-footer input[type="button"],#site-footer input[type="reset"],#site-footer input[type="submit"]{background-color:#cd2653;}.header-footer-group,body:not(.overlay-header) #site-header .toggle,.menu-modal .toggle{color:#000;}body:not(.overlay-header) .primary-menu ul{background-color:#000;}body:not(.overlay-header) .primary-menu > li > ul:after{border-bottom-color:#000;}body:not(.overlay-header) .primary-menu ul ul:after{border-left-color:#000;}.site-description,body:not(.overlay-header) .toggle-inner .toggle-text,.widget .post-date,.widget .rss-date,.widget_archive li,.widget_categories li,.widget cite,.widget_pages li,.widget_meta li,.widget_nav_menu li,.powered-by-wordpress,.footer-credits .privacy-policy,.to-the-top,.singular .entry-header .post-meta,.singular:not(.overlay-header) .entry-header .post-meta a{color:#6d6d6d;}.header-footer-group pre,.header-footer-group fieldset,.header-footer-group input,.header-footer-group textarea,.header-footer-group table,.header-footer-group table *,.footer-nav-widgets-wrapper,#site-footer,.menu-modal nav *,.footer-widgets-outer-wrapper,.footer-top{border-color:#dcd7ca;}.header-footer-group table caption,body:not(.overlay-header) .header-inner .toggle-wrapper::before{background-color:#dcd7ca;}.postid-20513 .content-col h2{font-size:40px;font-weight:700;text-transform:uppercase;color:#0a5a63;}@media only screen and (max-width:1024px){.postid-20513 .content-col h2{font-size:30px;}}@media only screen and (max-width:767px){.postid-20513 .content-col h2{font-size:24px;}}#wprmenu_bar .bar_logo{height:40px;}#wprmenu_bar .menu_title{top:-12px;}#wprmenu_bar div.hamburger{margin-right:10px;margin-top:0;}