Make a Referral - Hello CaptainK

At CaptainK we make it easy for you to request our services. Simply fill out our step-by-step referral form below. If you need any help while completing this form, you can request a call back at any time by clicking the Call Back button. Or if you prefer to discuss your referral, you can contact us on 0493370126 or email info@hellocaptaink.com.au and we can get you started.

Choose from below

I am a referrerI am a participant

My Details

Your role
ParentSupport PersonLAC/Support CoordinatorPlan ManagerOther

I would like to save my profile information for future referrals.

Participant Details

Do you need interpreting services required?
YesNo

Services

How would you/participant prefer to receive our services?
TelehealthFace-to-faceEither

Which services are you/participant interested in?
Community Nursing CareWound Assessment and Care PlanOngoing Wound CareBowel CareCatheter CareMedication ManagementComprehensive Continence Assessment, Quote, and NDIS reportComprehensive nursing assessments and report

Continence Assessment Service

Funding hours allocated for Continence Assessment
Note: We are unable to do a Comprehensive CA under 6-8 hrs based on individual circumstances. Kindly make sure there is sufficient funding for CA prior to sending the referral. CaptainK will only release the CA report once payment has been successfully received.

Please answer the following questions:

Reason of referral:

Is the person suffering from bladder incontinence?
YesNo

Is the person suffering from bowel incontinence?
YesNo

Is the person suffering from Urinary retention as a NEW diagnosis or symptom?
YesNo

Is Bladder Scanning required?
YesNo

Bladder Scan will only be conducted if there is a need or requirement based on an individual suffering from a suspected urinary retention as a NEW onset or requires a Trial of Void (TOV) post hospital discharge for successful catheter removal. For an individual with a known condition of a neurogenic bladder, bladder scanning for once off continence assessment is inconclusive and unnecessary. Please contact our continence clinician if you feel you still require one.

Please Tick whatever is applicable:

Adult CAPaediatric CAComprehensive Continence Assessment (includes nursing clinical assessment, Care plan, quote, and report 6-8hrs)Product Assessment, trial, and prescription only- No clinical assessment (5hrs)Ongoing Continence Catheter ManagementTraining of Support staff on strategies for bladder/bowel management, training client for self-catheterisation etc.

Note: For Continence Assessment referrals, please note that they do take time and cannot be done in 2 weeks subject to individual circumstances beyond our control such as delay in product delivery, feedback from carer staff about product suitability, outdated MDT report or information relayed during consultation requiring rigorous follow ups and tail chasing, etc.

Support coordinators, Participants, carers, or guardians are advised to allow a minimum 6-8 weeks’ time after first consultation for report writing. For NDIS participants, please send the referral once new plan is out or when there is about 8 weeks left prior to plan review. Thank you for your patience and thank you for trusting and using CaptainK for your continence needs.

Type of Plan

Service BookingPACE Plan

Type of funding
NDISHomecareCHSPDVAInsuranceOther