Before we begin

Complete this form if you are requesting services as the parent or guardian of a child. You will be the primary contact person for this enquiry.
Fields marked with are mandatory


Only a parent or guardian can request services for a child. Providing your information confirms your agreement to discuss services and share personal information with Vision Australia. We handle information in accordance with our privacy policy.

Your details

Step 1 of 4
Step 1 of 2
Fields marked with are mandatory


Maximum 32 characters

Maximum 32 characters

Enter 10 digits without spaces starting with ‘0’ for mobile or phone with area code.

If you do not have an email address, enter the email of a family member or carer, or call us on 1300 84 74 66.

Contact preferences



About the child

Step 2 of 2
Step 2 of 4
Fields marked with are mandatory
Please fill in the following information for the child for which you are the parent or guardian.

Their details


Maximum 32 characters

Maximum 32 characters


Maximum 4 characters

Their needs



Their vision

Step 3 of 4
Fields marked with are mandatory



Funding status

Step 4 of 4
Fields marked with are mandatory
If the child is eligible for a funding source or government support (such as NDIS) you need to access it to receive services from us. Alternatively, you can choose to speak to us about other options to access services.




Their needs