Submit a Referral

Take the first step toward quality, personalized disability support. Complete the form below and May will personally be in touch to discuss your needs.

How the Referral Process Works

Step 1

Submit Referral

Complete the referral form below with participant details and support needs.

Step 2

Personal Meeting

May will personally meet with you to understand your goals and preferences.

Step 3

Support Begins

Once the service agreement is in place, your tailored support journey begins.

Client Incoming Referral Form

Please provide the following information. All fields marked with * are required.

Referral Date *

Referral Managed By

Participant Details

Surname *

First Name *

Spouse/Partner Guardian Details (If applicable)

Surname

First Name

Contact Details

Home Phone

Mobile Phone *

Work Phone

Email Address

Address *

Referrer Details

Name *

Position

Organisation

Contact Details

Referral Reason *

Further Participant Details

Country of Birth

Preferred Language

Aboriginal or Torres Strait Islander?

Yes

Interpreter Required?

Yes

Other Support Required (specify)

Action Taken / Follow Up

Notes

Participant/Guardian Declaration

By signing this declaration, I acknowledge that I am voluntarily requesting services from Magnolia Helping Hands Pty Ltd. I understand that the personal information collected in this form will be used solely for the purpose of assessing my eligibility for services and coordinating my care. I consent to the collection and use of my information in accordance with Magnolia Helping Hands' Privacy Policy.

Full Name *

Date *

I agree to the above declaration and consent to Magnolia Helping Hands collecting and using my information as described. *

Note: This digital submission serves as your electronic signature for the declaration above.

What Happens Next?

Once we receive your referral, May will personally review it and contact you within 1-2 business days to arrange a meeting. This initial meeting is an opportunity to:

Discuss your goals, needs, and preferences in detail
Learn about Magnolia Helping Hands and our boutique approach
Ask any questions you may have
Begin building the personal connection that sets us apart