If you would like us to prepare a quote, please complete the form as below. We will endeavour to get back to you as soon as possible. If you do not hear back from us within 24 hours, please contact Sara on 0402 330 315 to confirm your request was received.

If you would like to request our services, please complete the form as below. We will endeavour to get back to you as soon as possible. If you do not hear back from us within 24 hours, please contact Sara on 0402 330 315.

• INSTRUCTIONS
  Please answer all questions that have a red asterix, otherwise the form may not submit. ** If the form has been completed in all areas, you will receive a copy to the email address you provided.
• Date of Request
  DD slash MM slash YYYY
• Person Making the Request*
  Enter your name
• Mobile Number
• Work Phone Number
• Email Address*
• Preferred Contact
  Mobile NumberWork NumberEmail Address
• Type of Service Required
  Daytime RespiteOvernight RespiteMentoringRestoration AssessmentSupervised ContactSupervised TransportYouth Work Supervision
• Details of Child/Young Person, required Service, and their Family Details

  Family Name	D.O.B. /Age	Male/Female	Address & Mobile No.	Legal Status	Cultural Background	Type of Car Seat Required

  Please list all the family, Carer's or approved to attend contact details above. eg. Mother, Father, Child, Carer of Children or Other persons approved to attend contact. Click the + button to ad new field to include all family members.
  
  *PLEASE NOTE: Any persons not listed as approved to attend a contact visit will be asked to leave, unless prior arrangements have been made and forwarded to NGADHI FAMILY SERVICES Management.
• Placement Details
  Put in details of the Name of the Carer or Parent, that the child is placed with, their address and best contact number.
• Details of any Children’s Court / Family Court Orders:
• Date or Dates (If Ongoing) of Service Required
• Details of Requirements for service
• Transport Required?
  • Yes
  • No
• Frequency of Transport
  Weekly/Monthly (particular days)
• Child Pickup Location and Time
• Child Protection Concerns:
• Child Drop off Location and time
• Safety Concerns
• Behaviour Concerns
  List any key concerns in regards to the child's behaviour, any special needs or ways they can best be managed.
• Any Special Requirements:
• School Details (if applicable)
  Name of School, Address and Contact Number of Principal
• Details of Current Doctor
  Name, Address, Phone Number
• Is a full medical check up required?
  YesNo
• If so, do you give us permission to get a full medical checkup for the child/and or young person?
  YesNo
• Medicare Details (if applicable)
  Medicare Number, Expiry and Reference Number on Card
• Current Medication
  Please provide details of any medication the child is on
• Attach Specialist Letters (if applicable) e.g. Pediatrician, etc
  Max. file size: 256 MB.
• If the service is a Mentoring Request, what areas/skills would you like us to focus on in the Mentoring Arrangement?
• Food Allergies (If applicable):
• Is a Report required?
  YesNo
• Type of Report
  Daily SummaryShift SummaryWeekly SummaryRestoration Assessment ToolJob Completion Summary
• Specific details to include in Report?
  If a report is required, what details would you like to see included in the report?
• Where to submit reports?
  Email address required
• Where to Email Quotes/Invoices
• Approved Expenses?
  Summarise what amount/items we are approved to spend on the child.
• Approved Kilometres?
  How many kilometres are we approved to travel with child on board?
• Attach Supporting documentation here
  Max. file size: 256 MB.
• Other (please specify):
• How did you hear about us?
  Another ServiceCo-workerFriendWebsiteOther

• Please Note

  Requesting Service, must inform Ngadhi Family Services, that a service is cancelled before 5:00pm, on the day before the service is scheduled. If the service is not cancelled in time, the Requesting Service will pay a cancellation fee: of the Agreed Cost per hour x 3 hours, plus cost of Staff Travel to the job site. If a service is requested after hours (after 5pm),the minimum rate is 3 hours of staff time plus cost of Staff Travel to the job site.

If you would like to provide us with some feedback, please fill out the form as below.

If you have a complaint, please complete the form as below. We will get back to you as  soon as possible and investigate the matter (where applicable). If you are unhappy with the outcome of our Investigations, you may make a further complain to the NSW Ombudsman as below:

NSW Ombudsman’s Office

General Enquiries (02) 9286 1000

Click here to navigate to the NSW Ombudsman’s Office Complaints Form