Make a Referral

Make a referral for an assistive technology assessment

Just call or fill out the form for a response in 1-2 business days

EquipAID’s Occupational Therapy home equipment and aid assessment services are available in Garden City, Docklands, Southbank, South Melbourne, Port Melbourne, Albert Park, Middle Park, St Kilda, Elsternwick, Brighton, Caulfield, Prahran, Sandringham, Bentleigh, and throughout metropolitan Melbourne by arrangement.

Equipment assessment services most commonly take place in the location where the equipment is intended to be used. This can include assessment in the home, community or workplace.

New/Previous Client *

New Client
Previous Client

Gender *

Male
Female
N/A

Date of Birth *

Name *

First

Last

Email *

Phone *

Address *

Suburb *

Postcode *

Date of Referral *

Referrer's Position *

Referrer's Email Address *

Please outline details for referral *

Source of Referral

Self
Family, Friend, Significant Other
Support Coordinator - NDIS
Other Disability Service
Community Nursing Service
HACC Assessment Authority
Aged or Disability Assessment Service
Acute Care Hospital
Psychiatric / Mental Health Facility
Other

If your source is not listed please type it below

Funding Body *

NDIS
TAC
WorkSafe
Other

If your funding body is not listed please type it below

If NDIS marked for funding body

NDIS plan dates (if applicable)

Plan manager details (if applicable)

Plan management details *

Agency managed
Plan managed
Self-Managed

Add supporting documents (If applicable)

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Comment

EquipAID Occupational Therapy. Adult Occupational Therapy home equipment and support assessment services to the Bayside region.

Nicola Sydes, BaAppSc. (Occ Therapy)
AHPRA Reg. No. OCC0002122279
NDIS Registered
SWEP Registered
WorkSafe Registered Provider
TAC Registered Provider
AON INSURED
OTA Member