Submitting a request for Equipment or Home Modification

• Equipment Request Form (DOCX 180.2 KB)
• Home Modification Request and Agreement Form (DOCX 97.2 KB)

Along with the above request form, all Category 2 items must also be submitted with:

• Delegate Approval Request Form (DOCX 57.9 KB)
• Risk Rating and Priority Scoring Form (DOCX 65.3 KB), or for Communication devices Priority Scoring Communication and Assistive Technology (DOC 170.5 KB)

An additional specification form may be needed if measurements or adjustments to the item need to be detailed.

• Checklist For Assessors Submitting Equipment Requests (DOCX 78.1 KB)
• Checklist For Assessors Submitting Home Modification Requests (DOCX 78.3 KB)

Please ensure that individuals and their carers read the following document prior to planning or starting major home modifications:

Major Home Modifications Client Information Sheet (DOC 176.5 KB)

Once an equipment item has been approved by the Equipment Program delegate, an Equipment selection agreement form (DOCX 61.0 KB) must be completed by the client and referring therapist.

Please see further information in the Ordering Section, to complete your request.