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Contact and Enquiry — Continuum Teletherapy and Allied Health
Whether you are a patient, carer, support coordinator, or just have a question, this is the right place to start. This form takes about 3 minutes. We will be in touch within
1 to 2 business days
.
Have a question first?
Visit our FAQ
.
Who are you?
*
Who are you?
A
Patient or family member
B
NDIS participant or support coordinator
C
Health professional or clinician
D
Aged care or disability organisation
E
General enquiry
About You
First Name
*
Last Name
*
Date of Birth
*
Email Address
*
Phone Number
*
Which State Are You In?
*
Are you referring yourself, or someone else?
*
Are you referring yourself, or someone else?
A
Myself
B
Someone else (family member, person I care for)
About Your Care Needs
Services You're Interested In
*
Services You're Interested In
How Are You Funding Your Care?
Not sure?
See our NDIS and Funding FAQ
. If your plan is NDIA-managed, you can still access Continuum privately — select that option and we'll explain your choices.
*
How Are You Funding Your Care?Not sure? See our NDIS and Funding FAQ. If your plan is NDIA-managed, you can still access Continuum privately — select that option and we'll explain your choices.
A
NDIS — Self-managed
B
NDIS — Plan-managed
C
NDIS — NDIA-managed (Agency-managed)
D
Private / self-funded
E
Medicare (if eligible)
F
Not sure
Tell Us About Your Situation
*
Do You Have a GP or Current Treating Doctor?
*
Do You Have a GP or Current Treating Doctor?
A
Yes
B
No
Do You Have a Support Coordinator, Carer, or Guardian?
*
Do You Have a Support Coordinator, Carer, or Guardian?
A
Yes
B
No
Support Coordinator / Carer Name
Support Coordinator / Carer Contact
How Did You Hear About Us?
*
Consent and Privacy
Your information will be handled in accordance with the Australian Privacy Principles and our
Privacy Policy
. By submitting this form, you consent to Continuum Teletherapy and Allied Health contacting you to discuss your enquiry and eligibility for services.
How Did You Hear About Us?
I consent to being contacted by Continuum Teletherapy and Allied Health
I confirm the information provided is accurate to the best of my knowledge
Submit Referral
