Lyft Community
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For support coordinators

Detailed intake form.

For support coordinators with full participant detail. If you're a family member or you don't have all the clinical information yet, the shorter referral form is a better starting point.

Before you start

What happens to this information.

The information you submit here is emailed directly to sammi@lyftcommunity.com.au and handled in line with our privacy policy. We collect it to assess service-provision requirements and to support the participant safely. Sensitive information (medical details, behaviour support plans, alerts) is only shared with the support team allocated to the participant.

All Lyft Community shifts have a minimum duration of 3 hours. Cancellations made with at least 72 hours' notice incur no fee — within 72 hours, the scheduled shift duration is invoiced.

Section 1

Person being referred

Gender
Cultural identity (select any that apply)
Communication (select any that apply)
Section 2

Outcomes for the person

What has the participant said they want in a support worker?

Days and times the participant has suggested they need assistance.

Section 3

About you (the referrer)

Has consent been provided by the participant or formal guardian?*
Section 4

Service required

Service types (select all that apply)*
Section 5

Person insights

Please complete what you know. This information helps Lyft assess service-provision requirements and build the right support team. Skip what doesn't apply.

Does the person have a history of sexual abuse or sexual acting out?
Does the person have behaviours of concern?
Are restrictive measures used?
Has the person experienced violence-related adversity? (e.g. domestic violence, bullying)
Does the person have a positive behaviour support plan?
Does the person pose a risk to themselves or others? (e.g. suicide ideation, self-harming behaviour, aggression)
Does the person have substance abuse issues?
Alerts (select any that apply)

e.g. peg feeds, seizure management

e.g. toileting, meals. Please provide medication details if relevant.

Section 6

Decision-maker details

Type

We'll confirm receipt within one business day.

Let's talk

Let's talk about what support could look like for you.

A 15-minute conversation. No pressure, no hard sell. Just a chance to hear where you're at, and see if we're the right fit.

0418 828 518
Book a 15-minute chatEmail us