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Service Request Form

Thank you for contacting the Astris Lifecare Service Team.

Please enter your details below, also note that all field marked with an asterisk are mandatory.

To ensure a timely response to your request, relevant images or documents also need to be attached.

This form constitutes an NDIS Participation authorisation when the applicable field are filled in and can only be used for orders under $1500.

 

Kind Regards,

The Service Team


Please use the form that is most relevant to you.

Service Request - Self Managed
Participant Address *
Participant Address
City
State/Province
Zip/Postal
Country
Maximum upload size: 2.1MB

In order to complete this service request we will contact you for payment over the phone. A service booking fee of $143 for basic call out charge (extra charges apply for work outside of Sydney Metro) will be placed prior to the service. A further service booking fee will be charged for additional parts and labour cost as necessary.

I agree to receive communications
Service Request - Plan Manager
Participant Address *
Participant Address
City
State/Province
Zip/Postal
Country
Maximum upload size: 2.1MB

Astris Lifecare will contact the Plan Manager to check availability of funding. Work will not proceed until sufficient funding has been confirmed in writing.

I agree to receive communications
Service Request - Agency Managed
Participant Address *
Participant Address
City
State/Province
Zip/Postal
Country
Maximum upload size: 2.1MB

A service booking fee of $143 for basic call out charge (extra charges apply for work outside of Sydney Metro) will be placed prior to the service. A further service booking fee will be charged for additional parts and labour cost as necessary.

I agree to receive communications
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