## 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**

## Main Contact Information:
- **Admin Name**
- **Client Name**
- **Phone Number**

## LusioMATE Player Information:
- **Player Name**
- **Player DOB**
- **Player Phone**
- **Subscription Type**  
  - Requested Purchase - SELECT ONE...  
    - Quarterly (AU$357/Qtr) - (Australia Only)
    - Outright (AU$1848) - Lifetime Hardware $1500 + 1 Yr Software License $348  
- **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**

## 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](/content/pages/ndis-orders-faqs/index.html) or download it [here](https://cdn.shopify.com/s/files/1/0058/7402/4508/files/LusioMATE_NDIS_Info_Sheet.pdf?v=1590021180).