Ready to make a referral?
To enable timely attention to your intake request if you could fill out your form with as much detail as possible. This will enable your amendment or clinical intake to be actioned quickly with us getting back to you with confirmation within 5 business days.
If you are NEW to AJH Disability & Health Services and would like to fill out our intake form please click on this link which will take you to our online intake form.
If you are an EXISTING PARTICIPANT with AJH and would like to request a new service, have a new plan or have funding or date changes please fill this form out.
If you have an EXISTING SERVICE with us and would like to update contact details for yourself or for a provider please fill out this form.
Would you like to make a referral?
Welcome!! Click here if you would like to submit an intake request.