Your Name *

NDIS Participant Name *

Participant Date of Birth *

Participant NDIS Number *

Email Address *

Phone *

Shipping Address *

Invoice Number *

Please select which Product or Service this order should fall under: *

Please see below table for a description of each service if you are unsure on what to select.

I confirm that the resources I have selected are reasonable and necessary supports related to the participant's disability and are likely to be beneficial to the participant. *

I give consent for a representative of Sensory Assist Pty Ltd to lodge the order *

I agree Terms and Conditions *

Thank you for submitting your NDIA service agreement. We appreciate your trust in our services.

Our team will review your submission carefully and get back to you as soon as possible.

If you have any immediate questions or concerns, please don't hesitate to reach out to our support team.

We look forward to working together to meet your NDIS needs.

Thank you for submitting your NDIA service agreement. We appreciate your trust in our services.

Our team will review your submission carefully and get back to you as soon as possible.

If you have any immediate questions or concerns, please don't hesitate to reach out to our support team.

We look forward to working together to meet your NDIS needs.

NDIS Service Agreement for NDIA Participants

Height(cm)	Size
Up to 110cm	Small
Up to 130cm	Medium
Up to 150cm	Large
Up to 170cm	X-Large
Up to 190cm	XX-Large