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Referral Form

Our easy online tool to initiate the processing of your referrals – fill out the form below.​

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You can also print and fill out the form and email back to us at admin@essentialplan.com.au.

Download Referral Form

Referral Form

Plan Management Referral Form

Use this form to refer a participant for plan management with EPSS.
This form can be completed in a few minutes. Optional sections can be skipped if the information is not available — we’ll confirm anything needed.
This form is primarily for Support Coordinators. If you are a participant, child representative, or plan nominee signing up directly, please use the Sign-Up Form instead.
Once submitted, EPSS will review the referral and contact the nominated person to confirm next steps and get things moving without delay.
Complete and email to admin@essentialplan.com.au. Please attach a copy of the participant’s NDIS plan where possible.

Section 1 — Consent

Has the participant consented to this referral and to their information being shared with EPSS for the purpose of setting up plan management?(Required)
A referral cannot be progressed without participant consent.

Section 2 — Participant details

Mode of Contact Preferred
Is an interpreter required?

Section 3 — NDIS plan information

How is your plan managed?
Is this the Participant’s first plan?

Section 4 — PACE plans

Is the participant’s plan in PACE?
If the participant’s plan is in PACE, EPSS must be endorsed as both My Provider and My Plan Manager before we can access funding, submit claims, or make payments. Without endorsement, invoices cannot be processed.
*If yes — has EPSS been endorsed?
EPSS details for endorsement: Business Name: Essential Plan Support Services ABN: 94 638 628 574 Provider Number: 4050064635 Postal Address: PO Box 85, Cannington WA 6987 Contact the NDIS on 1800 800 110 or via the NDIS webchat to complete endorsement.

Section 5 — Plan nominee, child representative, or OPA guardian

Does the participant have a plan nominee, child representative, or guardian arrangement?(Required)
*If yes — relationship to participant
Note: OPA guardianship carries automatic plan nominee status under the NDIS. For participants under OPA guardianship, EPSS communicates through the Support Coordinator as the primary contact. The OPA guardian does not need to be contacted directly for plan management purposes unless there is a specific requirement to do so.
(For example: child safety order, private legal guardian, court-appointed guardian. Include any details that would help EPSS communicate appropriately with the participant and their support team.)

Section 6 — Support Coordinator details

Section 7 — Referrer details (if referrer is not the Support Coordinator)

Complete this section if the referral is being made by someone other than the participant’s Support Coordinator — for example, another provider or service.

Section 8 — Primary contact for onboarding

Who should EPSS contact first to commence services?

Section 9 — Current providers (optional)

Section 10 — Additional information (optional)

Only include information relevant to invoice processing, communication, or risks that may affect service delivery. This section is optional — the referral can proceed without it. (Current diagnosis or disability, behaviours of concern, risks or considerations, communication needs).

Section 11 — Urgency and expected start date

When is plan management required to commence?

Section 12 — What happens next

Once we receive this referral, we’ll review the details and contact the nominated person to confirm next steps and get things moving without delay.
If the participant’s plan is in PACE and endorsement has not been completed, we’ll let you know what’s needed before invoices can be processed.
If you have any questions in the meantime, contact us on 0474 329 544 or at admin@essentialplan.com.au.