Sign up/Refer Someone

Participant Details Form

If you encounter any issues while submitting this form, you can manually send your details to contact@jppm.com.au

Please follow the steps below:

Provider Relationship Endorsement
Call NDIS 1800 800 110 and request a provider relationship endorsement for provider number: 4050123867
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Read and Agree to Service Agreement (click here to download) – you do not need to sign it – by submitting the Participant Form, uploading your plan and actioning the Plan Management Endorsement requirement, you are consenting that you agree with the terms in the service agreement and authorize us to start plan management services – you must read the service agreement or you will not be able to submit the form.
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Fill out Participant Details Form
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Your plan management portal – Once plan management set up is complete, you will receive an email with a link to register your login and set up to your smart device – Please head to the INFO LINKS tab on our website for instructions on setting up for Android and iPhone

NDIS Participant name (as per NDIS records)*

NDIS Participant number*

NDIS Participant Date Of Birth*

NDIS Participant Phone Number (not required for child - see Primary Contact below)

NDIS Participant Email (not required for child - see Primary Contact below)

NDIS Participant Address (as per NDIS records)*

Suburb

Post Code

State

Plan start date*

Plan end date*

Please select one of the below options to review and approve provider claims:
Auto Approval – invoices received by providers will be auto approved for payment without you reviewingUser Friendly Plan Management App - downloaded to your mobile device for you to log in and review and approve/decline invoiceEmail – A copy of invoices forwarded to you to review and then you let us know if approved for payment

Service Agreement commencement date*

Primary Contact - Please select one of the below options - all adult clients must include an emergency contact if a nominee is not listed:
NDIS NomineePrimary ContactParentEmergency Contact
Contact Name

Contact Email

Contact Phone Number

Support Coordinator Name/Organisation

Support Coordinator Name/Organisation Email

Support Coordinator Name/Organisation Phone Number

Upload

If you have a copy of the current NDIS plan, please upload it here. You can also email your plan to us later if you do not have a copy to upload here.
One file only. 10 MB limit. Allowed types: pdf, doc, docx, jpg, jpeg.

By submitting this form you are confirming that you have read and agree to the information provided in the service agreement and authorise JPPM to commence plan management services.