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Assessment for Minor Adaptation and Equipment

Self Assessment for Equipment and Minor Adaptations

Please only complete this form if you feel you may benefit from some basic equipment or minor adaptations for your home such as:

handrails at the front and / or rear entrance of your home
an additional stair rail
toilet equipment to help you get on/off your toilet and/or a commode
bed and chair raisers

If you are unsure what may help, please use our OT Referral Form

Are you completing this form for yourself, or on behalf of somebody else? * This field is required

Myself

Somebody else (I have their permission)

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