Sign-Up Form

Before you start, please take a moment to read our service agreement.

Online Sign-Up Form

Participant's Name(Required)

First Last

Participant Date of Birth(Required)

Address(Required)

Phone(Required)

Email(Required)

Preferred Method of Contact

NDIS Number(Required)

Plan Start Date

Plan End Date

Upload a Copy of Participant's NDIS Plan(Required)

Drop files here or

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 50 MB.

Would you like to access to our Participant Dashboard?

Yes

Please read the terms & conditions outlined in our EPSS Service Agreement.(Required)

I agree to the terms and conditions outlined in this service agreement. Only the Participant or Plan Nominee can sign.*

Does this participant have a Legal Guardianship, Advocate, or Child Safety order?*(Required)

Yes

If yes - Legal Guardianship, Advocate, or Child Safety Officer details

Name, email address, phone number

Name

First Last

Relationship to Participant?

Phone

Would you like the participant's monthly statements?

Yes

How did you hear about us?

Anything else we should know?

Links