Forest Allied Health NDIS Registration Form
Date of Birth
Street Address Line 2
Living Arrangements (with family, alone)
Support Person Email
Support Person Phone
Living with Participant yes/no
Both participant and support person
NDIS Coordinator (Name/Email)
NDIS Funding Type
Plan Manager (if relevant)
Plan Manager Email (if relevant)
Please confirm there is funding available for Occupational Therapy services in Participant's NDIS Plan. Funding must be available in the following category: Improved Daily Living (CB Daily Activity) A minimum Service Agreement of 4 hours x $193.99 per hour will need to be signed for OT Assessment, travel and identification of therapy needs/therapy plan. Please contact Forest Allied Health Occupational Therapy for quotes for different services available (see list below).
Yes (4 hours minimum required)
Unsure / No (please contact Forest Occupational Therapy prior to making referral)
Current NDIS Providers (Name/Type)
NDIS Plan Start Date
NDIS Plan End Date
Disability / Diagnosis
Other Medical History
To assist us with ensuring we allocate the most suitable Occupational Therapist for participant, please provide reason for Occupational Therapy Assessment (tick all that apply).
Home modifications (shower rails, hand rails on stairs, ramps)
Assistive Technology - low cost/low risk (e.g. shower chair, toilet seats, adapted kitchen aids).
Assistive Technology requiring prior approval from NDIS (high cost/high risk) e.g. scripted wheelchairs, shower commodes, beds, pressure cushions). These items involve equipment trials, quotes and OT report to NDIS.
Skill building (e.g. cooking, money skills, travel training, personal care skills)
Sensory assessment and intervention
Supported Independent Living /Specialist Disability Accommodation Assessment and Report
Comprehensive Functional Assessment and Report (Care needs assessment or Plan Review report)
Major /Complex Home Modifications (structural home modifications e.g. bathroom modifications for level access shower, ceiling track hoists, lifts). Please Note Forest Occupational Therapy does not currently offer OT assessment for Major Home Modifications.
Name of Person Completing Form
Confirm Email for Person Completing Form
If you wish to upload any reports, NDIS Plan or other documentation that may assist the OT with your assessment please attach here.
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