NDIS Payment Request Form

This Payment Request Form is to be completed if the NDIS participant is either PLAN-Managed or AGENCY-Managed. SELF-Managed participants can also use this form if you require a tax invoice to seek reimbursement from the NDIS.

We use the information on this form to either generate an invoice to your Plan Manager (if Plan Managed) or submit a service booking via the NDIS Portal (if Agency Managed).

In order for us to process your order using your NDIS funding, you'll need to provide us a few quick details on the Payment Request Form below: