Expression of interest

Tell us a bit about yourself and the services you need. This will help us provide the best response when we get in touch with you.

If you’re not ready to fill out this form yet, you can also use our simple contact form or call us on 1800 952 962.

Are you filling out this form for yourself or for someone else? *

For myself
For someone else

First name *

Last name *

Phone

Email *

Preferred contact method

Phone
Email

Relationship to client

Family member
Guardian
Friend
Support Coordinator
Other

Participant first name *

Participant last name *

Participant date of birth *

Day Month Year

Participant location *

I'm interested in

Supported Independent Living
Disability Aged Care
Transition to home
Nursing
Occupational Therapy
Physiotherapy
Dietetics
Behaviour Support
Support Coordination
Equipment
I'm not sure

Funding type

NDIS
My Aged Care
DSOA
LSA
Self-Funded
I'm not sure

How did you hear about us?

Web search
Social media
Local expo
Word of mouth
Other

Other (how did you hear about us)

Comments (maximum 1000 characters)

DHS will use information collected from this form for the purpose of evaluating your enquiry. You are not lawfully required to submit a response. In accordance with our privacy policy, DHS undertakes to treat any personal information provided by you as confidential and only for the purposes indicated above. Any information submitted will only be retained for such time as necessary to carry out the purposes for which the information is collected or as required by law. Email addresses and any other contact details you provide will not be provided to a third party or added to a mailing list without your consent. For further information please contact DHSDSintake@sa.gov.au.