Before starting please read our Guidelines for Funding

      Stage One (this stage) requires:

  • Details of rare disease/condition and your medical specialist's (not GP or therapist) email address

  • Proof (e.g, passport/Medicare card/birth certificate) of minimum 5 year Australian residency/citizenship

    Please Note: In Stage Two you will need to provide:

  • Private heath insurance information

  • Government assistance details

  • Quote/invoice for items/services being requested

  • Income and expenses details, and

  • Tax return/payslip 

 This form will automatically save. You can return at any time to finish. You can also copy the website address to use on another computer.

A) Applicant Information

Make sure you have appplied for the National Disability Insurance Scheme (when available in your area) before you apply to us
Max File Size: 50MB
Enter Applicant's Full Name
Enter Applicant Date of Birth (DD-MM-YYYY)
Enter Applicant Gender

Enter Applicant's Street Name and Number
Enter Applicant's Suburb
leave blank if same as above
Enter Email
Applicant Place of Birth, please provide State and Country