Provider registration form

Provider Registration Form

Complete and sign your NDIS provider registration agreement

Verify your email

We'll send a 6-digit code to confirm you control this address before you can submit.

Email address * Use a valid email address you can access.

Organisation details

Provide the information required for NDIA provider onboarding.

Organisation

Organisation name *

ABN * 11 digits, e.g. 12 345 678 901

Address *

NDIA provider

NDIA provider number * Digits only, 9–10 characters

NDIA provider name *

Name *

Position *

Email *

Phone * Australian number, 10 digits

Same as PRODA/RAM ADMINISTRATOR

Name *

Position *

Email *

Phone *

Same as PRODA/RAM ADMINISTRATOR

Name *

Position *

Email *

Phone *

Other

Software platform *

System notifications mailbox *

Sign & submit

Confirm authority details and sign to complete your onboarding submission.

Authority

Authority name *

Authority title *

Authority date * Set automatically (DD/MM/YYYY)

Declaration

This form collects the information required to onboard a registered NDIS provider to the Care Access system and to support related integration activities.

The information provided will be used by the NDIA and Care Access to verify organisational details, nominated contacts, software platform configuration, hosting arrangements, and the organisation's authority to access and use relevant services.

By submitting this form, the signatory confirms on behalf of the organisation that:

the information supplied is true, correct, and complete; and
any data accessed, managed, stored, or processed through these services will be handled in accordance with applicable NDIA privacy, security, and data management requirements, including the prohibition on hosting or accessing information from outside Australia.

I have read and accept the above declaration on behalf of the organisation. *

Signature *

Sign here

Submission received

Thank you. Your onboarding form and signed document have been submitted successfully. Our team will be in touch if anything further is required.