What is Louisa DaCosta Trust?

A compassionate, accessible digital platform providing financial assistance and trusted healthcare referrals to Australians experiencing hardship.

Organisation Application

Apply to Register Your Organisation

SA Health organisations can apply to register with the Trust so their clinicians can refer patients for financial assistance.

Your details

First name *

Last name *

Professional title / role *

Phone

Your email address *

Use an email you can be contacted on during the review.

Organisation details

Organisation name *

Organisation type *

Department / ward

Organisation phone

Website

Organisation email

Referrer accounts are validated against the registered organisation's email domain. Your work email must use the same domain as your organisation.

Organisation email domain *

Your work email (organisation domain) *

Must match the domain above.

Organisation address

Street address

Suburb

State

Postcode

Additional information

Anything else we should know?

By submitting, you confirm the details above are accurate. Your application will be reviewed by the Trust team.