Request services for my child

Fields marked with * are mandatory.

Before we begin

Complete this form if you are requesting services as the parent or guardian of a child. You will be the primary contact person for this enquiry.

Is the child currently receiving services from Vision Australia?

Yes, they are an existing client.No, or I'm unsure.

Do you have permission to submit the form for the child?

Yes, I am the parent or guardian of the child.Only a parent or guardian can request services for a child. Providing your information confirms your agreement to discuss services and share personal information with Vision Australia. We handle information in accordance with our privacy policy.

Request services for my child

Fields marked with * are mandatory.

Step 1 of 4

Step 1 of 2

Your details

What is your relationship to the child?

Your first name (Maximum 32 characters)

Your last name (Maximum 32 characters)

Your phone

Enter 10 digits without spaces starting with ‘0’ for mobile or phone with area code.

Your email

If you do not have an email address, enter the email of a family member or carer, or call us on 1300 847 466.

Contact preferences

Do you require an interpreter?

Yes, for languages other than English.No, I do not require an interpreter.

Select your preferred language

Request services for my child

Fields marked with * are mandatory.

Step 2 of 2

Step 2 of 4

About the child

Please fill in the following information for the child for which you are the parent or guardian.

Their details

Child's first name (Maximum 32 characters)

Child's last name (Maximum 32 characters)

Child's date of birth (DD/MM/YYYY)

Child's postcode (Maximum 4 characters)

Is the child of Aboriginal and/or Torres Strait Islander origin?

We ask this question to provide culturally appropriate, prioritised access to programs and services, and to improve overall health outcomes.

Their needs

What has prompted you to seek services on their behalf?

Is there anything you would like to tell us about the child or this service request?

By submitting this form, you confirm that you agree to the storing and processing of your personal data by Vision Australia as described in our Privacy Policy. The information you have submitted will be used to provide you with the most relevant content on Vision Australia services, news & events, and other opportunities for support

Request services for my child

Fields marked with * are mandatory.

Step 4 of 4

Funding status

If the child is eligible for a funding source or government support (such as NDIS) you need to access it to receive services from us. Alternatively, you can choose to speak to us about other options to access services.

Is the child connected to a funding source or government support?

Yes, they have fundingNo, they do not have fundingI'm not sure

Which organisation provides the majority of their funding?

NDIS (National Disability Insurance Scheme)I’m not sure who provides their fundingOther

Enter details on who provides their funding

Their needs

Is there anything you would like to tell us about the child or this service request?

By submitting this form, you confirm that you agree to the storing and processing of your personal data by Vision Australia as described in our Privacy Policy. The information you have submitted will be used to provide you with the most relevant content on Vision Australia services, news & events, and other opportunities for support

Request services for my child

Before we begin

Request services for my child

Your details

Contact preferences

Request services for my child

About the child

Their details

Their needs

Request services for my child

Their vision

Request services for my child

Funding status

Their needs