Sign Up Form

Please complete the form below for us to be able to provide you with a Quote and / or an Invoice for LusioMATE.

Lusio Account:

To login to the Lusio games and Hub, you'll need an account. We will use the email below to create it for you.

Email Email

Main Contact Information: (Parent, carer / guardian, or main contact at business details)

Admin Name

Clinet Name

Phone Number

Client Name

LusioMATE Player Information:

Player Name

Player DOB

Player Phone

Subscription Type Address

Physiotherapist Details:

Physio Name

Physio Last Name

Physio Company Name

Physio Phone

Physio Email

Occupational Therapist Details:

OT Name

OT Company Name

OT Phone

Client name

NDIS Information (if applicable):

If you would like to claim the cost of LusioMATE from the NDIS, please provide the information below:

Client name NDIS Number

How did you find Lusio?

How did you find us

Any additional requests?

Any additional request?

Need more info? Check NDIS Info Sheet here or download it here.