Online registration

Request a continence assessment

Complete the form below to register for a nurse-led continence assessment. The more detail you can provide, the better we can prepare for your appointment. All fields marked with * are required.

Confidential & secureRegistered nurse assessorsNurse will call you back

Step 01

What are you enquiring about?

Pick the service that best matches what you need. We'll direct your enquiry to the right specialist nurse — you can still change it if you're not sure.

Service *

Step 02

Your contact details

Tell us how to reach the person submitting this request. If you are not the participant, you'll add their details in the next section.

Full name *I am *Email address *Phone number *

Step 03

Participant details

The NDIS participant who will receive the assessment.

Participant first name *Participant last name *Date of birth *DD/MM/YYYYNDIS numberUsually a 9-digit number on the participant's plan.

Language spoken at home

Step 04

Residential address

So we can confirm whether in-home assessment is available in your area and plan travel time.

Street address *

Address line 2 (optional)

Suburb *

State *Postcode *

Step 05

NDIS plan information

Helps us confirm the right funding category for your continence assessment and report.

Plan management

Plan start datePlan end date

Step 06

Support team (optional)

Add details for your support coordinator, plan manager, or GP so we can keep everyone informed.

Support coordinator / plan managerTheir email or phoneGP or treating doctorPractice name

Step 07

Nominee or representative (optional)

A family member, carer, guardian or nominee who can be contacted on behalf of the participant.

Nominee / representative nameRelationship to participantPhoneEmail

Step 08

Assessment preferences

Tell us how and when you'd like the assessment to take place.

Preferred formatAccessibility or support needs

Preferred days or timesFor example, weekday mornings, after 2pm, school hours.

Step 09

Clinical context

A short summary helps our nurse prepare with the right kit. You'll have plenty of time to share more during the appointment.

Brief description of what you needInclude any current continence products, catheters, or bowel routines.

Relevant diagnoses or conditions (optional)

Step 10

Consent & signature

Please review and acknowledge each item below, then sign to confirm your request.

How did you hear about us?

I consent to National Continence Solution contacting me about this assessment request by phone, email or SMS.I consent to relevant assessment information being shared with the participant's nominated support coordinator, plan manager or treating clinicians where appropriate.I have read and accept the Privacy Policy and understand how my personal and health information will be collected, stored and used.I confirm the information provided is accurate to the best of my knowledge, and I am authorised to submit this request on behalf of the participant.

Full legal name (typed signature) *Typing your full name acts as your electronic signature for this request.

Ready to submit?

Our team will be in touch within 1–2 business days. Prefer to talk it through? Call 1300 000 000.