If you or someone you support is eligible for NDIS funding and seeking specialist eating disorder services, our NDIS referral form makes it easy to begin the process. At Myrtle Oak Clinic, our experienced psychologists and dietitians support individuals, adolescents and families across the Central Coast and Newcastle. Complete the form below to start your referral, and our team will contact you with next steps and service details.








    Plan Information



    Which section of the plan are you wishing to claim funds from?


    How do you manage the plan? (and how do you arrange payment for services)





    Have you added Optimum Intake as a My Provider in your NDIS plan (for plan or agency managed participants only)?

    Where would you like services provided? (Please note that where safety is a concern clinic visits are required).

    If Home visit: Is this accommodation a Group Home/SIL?

    Is this person fed via a PEG?

    Risk Assessment

    Safety Questions. Where a safety risk may be present, we may limit services to clinic-based services only.

    Is this participant in control of their behaviour at all times?

    Does this participant use recreational drugs in the home?

    Does this participant have a history of violence or aggression?

    Will a Support Worker or other representative be present during all visits?

    Parent/Guardian/Carer

    Full Support Co-ordinator name:

    Who provides consent for this Participant?


    Who shall we contact to book the appointment?

    Details of current plan

    Is there anything else you feel we should know before booking the first appointment?