Contact us: 1300 130 302
Equipment Program

Prescription and Request Forms

Equipment needs to be ordered using a prescription form. Select the correct form, depending on the funding that is being used and the category of the item.

Category 2 items also require:

  • Delegate approval form
  • Risk Rating and Priority Scoring Form OR Priority Scoring Communication and Assistive Technology.

Additional forms (for example, screening tool, specification form) may also be required for more complex prescriptions. This enables the appropriate item to be provided to meet the person’s needs.

All prescription and request forms can be faxed to 1300 295 839 or emailed to

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Last updated:06 Nov 2023 11:47am
Provided by:
Department of Human Services
Last Updated:
27 Mar 2018
Printed on:
07 Dec 2023
The Equipment Program website is licensed under a Creative Commons Attribution 3.0 Australia Licence. © Copyright 2016