Expression of Interest

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Thank you for taking the time to fill out this Expression of Interest form. At CAN & ABLE, disability supports, care, mentoring & community engagement is delivered to you by friendly and efficient fully qualified support workers. We endeavour to come along side the client to further their goals and assist in their daily living tasks and/or endeavours.

This form will allow us to better assist you and link you with the right services for your needs. We will be in contact at our earliest convenience.

What is your Name? *

Best contact?

Please provide email or phone #

How old is the person in need of mentoring at Can and Able? *

What are you main areas of need or concern?

Does the person you are filling this form in for have a diagnosis? If yes, what is their diagnosis and when were they diagnosed?

What is your child's or your main form of communication?

Vocal Speech (not easily understood by strangers)

Vocal Speech (age appropriate)

Non Vocal (hand leading, gestures, behaviours)

Key Word Sign or Australian Sign Language

PECS

speech generating device on a tablet (e.g Prologuo2GO)

OTHER

Clear selection

Does your child or you engage in any Distressed behaviours?

Self Injury

Aggression toward others

Property Destruction

Meltdowns/ Tantrums

N/A

Other

Clear selection

When would you like to begin services

Submit

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