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About Us
Our Team
Disability Services
Private Services
- The First Steps
- Rebates
School Services
- School Screenings
- Staff Training
Groups & Workshops
White Zebra Foundation
- Our White Zebra Foundation
- Support White Zebra Now
Contact

Menu

Home
About Us
Our Team
Disability Services
Private Services
- The First Steps
- Rebates
School Services
- School Screenings
- Staff Training
Groups & Workshops
White Zebra Foundation
- Our White Zebra Foundation
- Support White Zebra Now
Contact

Referral Form

Welcome to our online referral form! Here are some initial questions to ensure we are the right provider for you.

Which region do you live in?*
- South Metro
- North Metro
Unfortunately, we do not service the North Metro area. Please try your local providers.
How old is the person being referred?*
- 0-18
- 18+
We specialise in working with young children and adolescents, and therefore we may not be the most suitable provider for you. Please try contacting some adult providers or give us a call to discuss your specific needs.
Do you currently have or are planning to get an NDIS Plan?*
- Yes
- No
Great! Now for some more information... Please click continue to proceed.
Does your child have a diagnosed disability or developmental delay?*
- Yes
- No
Please feel free to upload any documents you think may be beneficial in determining whether we are the right service provider for you. These documents will be stored in a password protected electronic file and deleted if you do not end up accessing our services. We will not share them with anyone outside of our organisation without your consent
Max. file size: 128 MB.
Thank you. Now for some more information... Please click continue to proceed.
You may be eligible for NDIS funding – please click continue to fill in your details on the next page and contact us via phone to discuss the process for applying for funding.
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Contact Us

Booragoon

Lots 4-6, First Floor Booragoon Commercial Centre,
177 – 179 Davy Street, Booragoon WA 6154
Phone: (08) 9317 7932

Southern River

Unit 5b, 714 Ranford Road, Southern River 6110
Phone: (08) 9485 0056

Rockingham

Waikiki Specialist Centre, Suite 7, 217 Willmott Drive, Waikiki
Phone: (08) 9317 7932

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