{"id":21,"date":"2026-02-18T23:19:39","date_gmt":"2026-02-18T12:19:39","guid":{"rendered":"http:\/\/jr-technologiesweb.com\/devsite\/7-help-services\/?page_id=21"},"modified":"2026-03-06T17:34:20","modified_gmt":"2026-03-06T06:34:20","slug":"referral","status":"publish","type":"page","link":"https:\/\/jr-technologiesweb.com\/devsite\/7-help-services\/referral\/","title":{"rendered":"Referral"},"content":{"rendered":"<div class=\"inner-page\">\n<div class=\"container\">\n<div class=\"row justify-content-center\">\n<div class=\"col-lg-8 col-md-10\">\n<div class=\"referral-form\">\n<div class=\"form-title2\">Make a Referral<\/div>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f126-o1\" lang=\"en-AU\" dir=\"ltr\" data-wpcf7-id=\"126\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/devsite\/7-help-services\/wp-json\/wp\/v2\/pages\/21#wpcf7-f126-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"126\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_AU\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f126-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"inner-form-box mt-3\">\n\t<div class=\"ref_form_title\">\n\t\t<p>Participant Details\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"frm_fld col-lg-6 col-md-6\">\n\t\t\t<div class=\"frm_label2\">\n\t\t\t\t<p>Name of participant\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"participant-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"participant-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"frm_fld col-lg-6 col-md-6\">\n\t\t\t<div class=\"frm_label2\">\n\t\t\t\t<p>Telephone of participant\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"participant-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"participant-phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"frm_fld col-lg-6 col-md-6\">\n\t\t\t<div class=\"frm_label2\">\n\t\t\t\t<p>Email of participant\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"frm_fld col-lg-6 col-md-6\">\n\t\t\t<div class=\"frm_label2\">\n\t\t\t\t<p>Address of participant\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"participant-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"participant-address\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"frm_fld col-lg-6 col-md-6\">\n\t\t\t<div class=\"frm_label2\">\n\t\t\t\t<p>Date of Birth\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"dob\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text walcf7-datepicker\" aria-invalid=\"false\" placeholder=\"DOB\" value=\"\" type=\"text\" name=\"dob\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"frm_fld col-lg-6 col-md-6 half_check\">\n\t\t\t<div class=\"frm_label2\">\n\t\t\t\t<p>Gender\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"gender\" value=\"Male\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"gender\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"inner-form-box\">\n\t<div class=\"ref_form_title\">\n\t\t<p>NDIS Details\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"frm_fld col-lg-12 col-md-12 half_check\">\n\t\t\t<div class=\"frm_label2\">\n\t\t\t\t<p>Plan *\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"plan\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"plan\" value=\"Plan Managed\" \/><span class=\"wpcf7-list-item-label\">Plan Managed<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"plan\" value=\"Self Managed\" \/><span class=\"wpcf7-list-item-label\">Self Managed<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"plan\" value=\"Agency Managed\" \/><span class=\"wpcf7-list-item-label\">Agency Managed<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"frm_fld col-lg-6 col-md-12\">\n\t\t\t<div class=\"frm_label2\">\n\t\t\t\t<p>Plan Manager Name (If Applicable)\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"plan-manager-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"plan-manager-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"frm_fld col-lg-6 col-md-12\">\n\t\t\t<div class=\"frm_label2\">\n\t\t\t\t<p>NDIS Number *\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ndis-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ndis-number\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"frm_fld col-lg-6 col-md-6\">\n\t\t\t<div class=\"frm_label2\">\n\t\t\t\t<p>Plan Start Date *\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"plan-start-date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required walcf7-datepicker\" aria-required=\"true\" 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