Participant intake form
Tell us what help you want. The form stays short for ordinary support and opens extra questions only when they are relevant.
Before you begin
Complete it your way
You can fill this out in your own time, or someone can help you work through each section.
Only share what is relevant
Health, behaviour and personal information only need to be included when they affect your support or worker safety.
Who are we supporting?
Basic information for contact, service delivery and invoicing.
Add an exact day or time
Add another communication need
Add a family member, nominee or other contact
Complete this only if you would like another person involved in decisions or contact.
How will the service be funded?
We only need enough plan information to confirm that the requested service can be provided and invoices go to the right place.
Add plan dates, budget or funding instructions if you know them
Plan manager
Add a support coordinator or recovery coach
We are not providing support coordination. Complete this only if you would like us to communicate with your coordinator about our services.
What would you like help with?
Start with the ordinary support you want. Open the additional-support choices only if they apply.
Personal care, medication, mobility or another support
Add something not covered by the choices
Optional: add boundaries or things a worker should not do
When and where is support needed?
Enough information to decide whether we have a suitable worker and prepare a clear service arrangement.
Add another acceptable time
Optional: add who is present or how roster changes should be communicated
Add somebody else
Add another roster instruction
What makes a good support relationship?
This is where we understand you as a whole human being, not just the service you need. It helps us find a worker you can genuinely feel comfortable with.
Mostly clicking from here.Choose every answer that sounds right. Open an “add something else” box only when the choices do not cover it.
Add something else about yourself
Show more interests
Add an interest that is not listed
Add another activity or conversation topic
Add something else that helps
Add another thing that can make support difficult
Add another personality preference
Add the specific language, cultural or other preference
Add another skill or anything that would make a worker unsuitable
Add a question or meet-and-greet request
How should workers provide the support?
This section appears only when the selected support needs more detailed communication, routine, personal or safety instructions.
Tap the instructions that fit.You can still add exact personal instructions underneath when they are needed.
Add specific communication instructions
Add more about independence or help
Add a routine, privacy or household boundary
Add agreed limits or instructions
A few details about the help you want
Only the services selected earlier appear. Ordinary support stays click-first and short.
Cleaning and household tasks
Add cleaning details, priorities or safety information
Personal care
Add exact personal care instructions
Meals, eating and drinking
Add food preferences or exact safety instructions
Transport and community access
Add a destination, vehicle detail or cost arrangement
Medication support
Mobility, transfers and manual handling
Add other equipment or transfer details
Social and community support
Add a place, boundary or cost arrangement
Daily living support
Add a task or prompting instruction
Other requested support
What does a worker need to know to keep your support safe?
This is not a full medical history. Simple support only needs a quick safety check and emergency contact. Extra questions appear when an instruction or plan is relevant.
Choose only what affects support or safety.Open an instruction box when a worker needs an exact response, contact or participant-specific method.
Add exact health, behaviour or safety instructions
Emergency contacts
Current plans or instructions to obtain
Your consent
Please confirm how Honourable Support may use the information in this form.
Review the participant intake
Check your answers, correct anything missing and send the form privately to Honourable Support.