Provider Access

SafeMate Resources

Welcome to the Provider Access Portal for SafeMate Resources. Here, providers can conveniently access brochures, provider purchase forms and the Department of Veteran Affairs referral form. Please note: If you get a 'Bad Request' when you try and download the form, then click on your Adobe icon on the top right hand side of your screen.

SafeMate Client Brochure

Download

SafeMate Provider Purchase Form

Download

DVA Referral Form

Download

DVA RAP Mobility & Functional Support Products

Download

Our Partners

Provider Purchase Form

First Name

Last Name

Phone number

Organisation

Reason

Client Contact Details

Please only enter here if your client has confirmed with you they consent to their details being passed on to Safe Mate Australia.

SafeMate abides by The Privacy Act 1988 (Privacy Act) in which personal information is never shared or sold to third party organisations.

My client has consented to being contacted by Safe Mate Australia in order to complete a purchase for their use.

Client's Name

First Name

Last Name

Phone number

Client's Address

This is so we know where to deliver their SafeMate kit.

Country/region

Address 1

Address 2

City

State

Postal/ZIP code

Client Notes

Please feel free to add any notes on behalf of your client.

If they have a carer who you prefer we contact directly you can place their contact details here.

Client Notes

Provider Name

If different from above.

First Name

Last Name

Provider Email

If different from above.

Provider #

Provider ABN

Provider NDIS #

Membership Type

Membership Fee

Please note: a fee of $35.00 is charged for the first year, followed by $20.00 annually.

Profile Creation

My client would like SafeMate to complete Profile upload - Additional $35.00

Yes No

Agreement

You may cancel this authorisation anytime by emailing us at hello@safemate.care or by calling (07) 3184 9109. This authorisation will remain in effect until cancelled in writing by you.

I hereby authorise Safe Mate Australia Pty Ltd to charge my Provider for the agreed-upon membership and annual fees. I understand this information will be saved on SafeMate’s secure payment platform for future transactions on my account. I agree to update SafeMate if I change my Provider.

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Provider Access Portal

SafeMate Resources

SafeMate Client Brochure

SafeMate Provider Purchase Form

DVA Referral Form

DVA RAP Mobility & Functional Support Products

Our Partners

Provider Purchase Form

Client Contact Details

Client's Name

Client's Address

Client Notes

Provider Name

Agreement