At CentacareCQ we strive to make things easy for you – including registering for NDIS Plan Management. Please complete the form below and we’ll take care of the rest! If you have any questions or concerns you can call us on: 1300 523 985 or click here to send us an email Participant Details Please Note: All details must match those listed on the participants NDIS plan.Participant Name*Participant Date of birth* Date Format: DD slash MM slash YYYY Address Street Address City/Suburb State / Province / Region ZIP / Postal Code NDIA Participant Number[The NDIA Participant Number can be found on the first page of your plan along with your NDIS Contact information. Click here to see a sample plan]NDIA Plan Start Date Date Format: DD slash MM slash YYYY NDIA Plan End Date Date Format: DD slash MM slash YYYY Has "Plan Managed" been approved in your current plan?Please SelectYesNo[This is identified in your plan under your Capacity Building Supports and is named Improved Life Choices (CB Choice & Control). Click here to see a sample plan]Please attach a copy of your planAccepted file types: jpg, png, doc, docx, pdf, gif.(or alternately, we will request this from you at a later stage)Participant / Advocate Contact DetailsNominee Name (If this is your NDIS plan, simply write your name)*Email Address* Contact Mobile*Relationship to ParticipantPlease SelectI am the participantI am the motherI am the fatherI am the husbandI am the wifeI am the sisterI am the brotherI am the auntI am the unclesI am the COSI am the CarerI am someone else (not listed)How did you hear about CentacareCQ's NDIS Plan Management?Please SelectPress AdvertisingRadioGoogleFacebookWebsiteExpo / Meet & GreetFamily MemberFriendSupport ProviderOtherDetails Check*I agree the details I have provided are correctCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.