Health Ladder Australia PTY LTD

Participant Details

First Name *

Last Name *

Email Address (Login Username) *

Phone Number *

Date of Birth *

NDIS Participant Number *

Password *

Confirm Password *

Delivery Address

Street Address *

City / Suburb *

State *

Post Code *

NDIS Funding Management

Funding Type * This funding type will be securely saved to your account and automatically selected at checkout.

Support Coordinator (Optional)

If you have a Support Coordinator managing your services, you may provide their details below.

Coordinator Name

Organisation

Email Address

Phone Number

NDIS Terms & Authorisation

All confirmations below are mandatory to complete NDIS registration:

The information supplied is accurate and current. * The person creating the account is authorised to place orders on behalf of the participant, where applicable. * The participant understands that an NDIS account does not automatically mean that every product purchased will be funded by the NDIS. * For plan-managed participants, the customer authorises Health Ladder Australia to send relevant invoices and order information to the nominated Plan Manager. * I agree to the NDIS Customer Terms and Conditions. *

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