Refer a participant

NDIS-funded all-abilities fitness · Geelong & Ballarat. Alex reviews each referral within one business day.

Region

Which region will this participant train in?

📍 Ballarat 📍 Geelong

First name

Last name

Date of birth

Participant phone

NDIS number (if known)

Plan management

What's the participant working towards?

Medical alerts / things we should know

Your name

Your role

Your email

Your phone

Organisation (if applicable)

Notes for Alex

By submitting you confirm you have the participant's permission to share these details with Circle Square.