RESOURCES

Our Resource Purchasing Request Form is for existing Learn For Life Occupational Therapy clients. Please contact Learn For Life if you require assistance to complete this request. For new clients, please contact Learn For Life on 1300 199 848 or info@learnforlifeot.com if you would like assistance to purchase resources.

Client Name *

First

Last

Client Date of Birth *

Parent / Carer Name *

First

Last

Contact Number *

Email *

Occupational Therapist Name

First

Last

Has this resource been recommended by the treating occupational therapist? *

• Yes
• No

Resource Funding Method *

• NDIS
• Private Invoice
• Other (please provide details)

Other Funding Method

Resource Requested *

If you have already sourced a resource or your occupational therapist has recommended a specific resource, please provide details. If you are yet to source a product and you require assistance please leave fields blank and we will contact you to provide further assistance.

Quantity *

Resource Supplier

Resource Cost

Delivery Address *

Additional Information

Resource Purchasing Agreement *

• I Agree

The information that I have provided is true and accurate at the time of this request. I consent to Learn For Life purchasing resource/s on behalf of the client. I understand that it is my responsibility to pay for resources purchased on behalf of the participant should NDIS funds be insufficient.

Submit