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LINK INTO LIFE INTAKE FORM

CLIENT DETAILS

First name *

Last name*

Preferred Name

Preferred Pronoun

Gender*

Date of Birth*

Day

Month

Year

Email*

Home Phone

Mobile Phone*

Home Address*

Postal Address

Best method to contact you?*

Phone

Email

Mail

In person

Do you need a interpreter?

Yes

No

Language Spoken *

Do you identify with any cultural or diverse group?*

Yes

No

Emergency Contact (Who can we contact if we cannot reach you)

Emergency Contacts Name & Phone Number*

Emergency Contact Email

Emergency Contacts Phone Number*

NDIS Number*

Relationship to the Participant*

Plan Start Date*

Plan End Date*

How is your plan managed?*

Plan Managed

Self- Managed (Participant)

Agency Managed (NDIA)

If Plan Managed

Plan Managers Email

We are proud to have a First Nations woman on our team and are committed to creating a culturally safe workplace and delivering culturally respectful services to the people we support.

We currently are based in Darra Qld, but our work extends out across greater Brisbane and so we acknowledge the Traditional Custodians of the lands and waters across our service footprint, extending from Burpengary down to Logan and Beenleigh, and west across Brisbane to Laidley. We recognise the Kabi Kabi, Jinibara, Turrbal, Yuggera, Yugambeh, Ugarapul, and Yugarabul peoples as the original owners of these regions. We pay our deep respects to their Elders past, present, and emerging, and extend that respect to all First Nations peoples visiting our website

NDIS Provider Number 405 005 0702

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Complaints and Feedback Procedure

© 2026 by Link Into Life. All rights reserved.

Email: admin@linkintolife.com.au

Phone: +61 421 183 825

Address: 1 Westlink Court, Darra, QLD 4076

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