Make a referral

Name: Breakthrough Behaviour
Address: Canberra, ACT, AU
Telephone: +61262000000

Complete the form below and we'll be in touch within 2 business days. All referrals are welcome — from participants, families, carers, and support coordinators.

Participant details

First name

Last name

Date of birth

NDIS number (if known)

Contact details

Who should we contact about this referral? This may be the participant, a family member, carer, or support coordinator.

Full name

Relationship to participant

Phone number

Email address

Referral details

Service requested

NDIS plan management

Support coordinator name & organisation (if applicable)

How did you hear about us?

Additional information

Fields marked with * are required.

What happens next?

1
We review your referral and confirm receipt within 2 business days.
2
Our Executive Director contacts you to discuss the participant's needs and answer any questions.
3
We schedule an initial assessment at a time that suits you.
4
Support begins — with a plan tailored to the participant and family.

Prefer to call?

We're happy to take referrals over the phone or answer any questions before you submit.

(02) 6200 0000

[email protected]

Canberra, ACT, Australia

Mon–Fri, 9am–5pm AEST

Funding Lines We Can Access

Improved Daily Living
Community Access Funding
Early Intervention
Respite (STA)
Personal Training
Specialist Behavioural Intervention Support
Behaviour Management Plan Including Training in Behaviour Management Strategies