Enquire about supports

Thank you for choosing us! We need a bit of information before we can get started.
This form will take about 5 - 10 minutes to complete. We will contact you after you have completed this form to discuss services.
I am completing this for: * Required
- Myself
- Someone else (child / someone I care for / I am referring someone else)
Where did you hear about Kern?
- Google
- Kern Staff
- NDIS
- Social Media
- Support Coordinator Capacity Newsletter
- Traditional Marketing (brochure, newspaper)
- Website
- Word of Mouth
- Other
Other

Additional information
Can you describe the support you are seeking or your needs? * Required
Preferred location you wish to receive supports (Suburb or school name)? * Required
As a mobile therapy provider, Kern provides supports where you need it most, in the home, school or community setting across the southern Perth, Bertram and Mandurah region. We also offer clinic-based support within our Bertram and Mandurah clinic.
Are there any days and / or times that you are unavailable for therapy?
Are there any challenges that the participant, family or friends are experiencing that we should know about? (e.g. separation, grief, housing, financial concerns)
Is there anything else that you would like us to know so that we can better support you?

Thank you for choosing us! We need a bit of information before we can get started.