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Enquiry Form ALL
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Last Name
Email
Phone/Mobile
Address
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NDIS # (if applicable)
Preferred Contact Method
Primary Disability/Disabilities
Funding Type
1:1
1:2
1:3
1:4
Plan Type
Self-Managed
Plan-Managed
NDIA-Managed
Do you have any mobility issues
Yes
No
Please describe your level of Mobility
Service/s I am interested in (select as many as you would like)
Respite/STA
Yoga/Meditation/Reiki/Sound Healing
Psychosocial Recovery Coaching
Support Coordination
Respite/STA
Length of Stay
Preferred start date of STA/Respite
Activities - please select all that you would like to do
Reiki
Yoga
Meditation
Float Therapy
Infra Red Sauna
Singing Bowl Therapy
Theme Park Day
Theme Park 3 Days
E-Scooter / Bike Riding
Table Tennis
Electronic Gaming
Board Games
Bushwalking
Fishing Charter
Cinema
Theatre / Show
Shopping Centre
Kayak Tour
Australia Zoo
Local Market
Jet Skiing
Arts & Crafts
Infinity
Whale Watching
Queensland Museum
Mini Golf
Golf
Lawn Bowls
Ten Pin Bowls
Further Information
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