Book My Home Modifications Please enable JavaScript in your browser to complete this form.Participants Name *FirstLastGenderFemaleMaleThey Them or OtherNDIS Participant number *Best Contact Name to discuss modifications *Best Contact Number *Best Contact Email *Occupational Therapist *Occupational Therapist Number *Occupational Therapist Email *Support Coordinator Name *Support Coordinator Number *Support Coordinator Email *Home Modifications Work needed Minor ModificationComplex ModificationIf Complex Modification please provide building construction practitioner details Name - Email - Contact numberHow is the project funded? Plan ManagedSelf ManagedNDIA ManagedPersonal / Participant / FamilyHome Modification RequiredKitchen or Laundry - Structural WorkRamp - StructuralStair Climber or Stair / Platform LiftElevatorAirconditioningCeiling HoistMHM - BathroomMHM - Electrical and Door AutomationMHM - External DoorMHM - FlooringMHM - Internal DoorMHM - KitchenMHM - LaundryMHM - Other works including BedroomMHM - Pathway - ExternalMHM - RampMHM - Toilet ReplacementMHM - Cabinetry AlterationsMHM - Practical CompletionWhat housing modifications are you looking to achieve? *Bullett point reference is a good start e.g. * Bathroom * Kitchen * Chair LiftWhat else do we need to know before the first appointment *Bullett point reference is a good start e.g. * Down driveway to to the left to the Pink House * DOG - Please call when you have arrived so we can let you in. Submit
