Ready to book?Complete the Booking Form below and we’ll be in touch. Program Selection * Which Be Well Be Me program would you like to be a part of? If you're unsure, please refer to the Programs page on our website. Be Me Self-Care - begins 25 July Mini Gatherings - coming soon Do you live with a mild to moderate level of intellectual disability? * Note: Be Well Be Me only provide lifestyle programs aimed at adults living with a mild to moderate intellectual disability. Yes Unsure Attendee Details - Name * First Name Last Name Email * Phone * (###) ### #### Date of birth * Your Goals * Please tell us which goals you want to work on. Select all that apply. Self-care Social connection Community participation Other Support Requirements * What level of support do you require? For example, are you attending the program by yourself or do you require additional support. Accessibility * What are your requirements? This can include mobility, visual, sensory or auditory impairments. Write N/A if this does not apply to you. Communication * What is your preferred method of contact? Email Whatsapp Text message Mobile Other Payment Options * How do you intend to pay for your 'seat' at our one of our programs? Claim via NDIS Plan Personal means Combination of NDIS Plan and personal Unsure How is your NDIS Plan managed? * Be Well Be Me can only provide invoices for plan or self managed plans Plan Managed Self Managed NDIA Managed How did you hear about us? * Word of Mouth Support Coordinator Google Other Message Thank you for booking with us!One of our team will be in contact with you within the next 48 business hours.
