Continence equipment prescription and order form: Community form (for provider use only)


For community continence nurses – use this form to request continence equipment for your patient. You will need to provide a summary of the continence assessment, along with your recommendations.

The form should also be completed when a major review of the continence equipment requirements is conducted (usually every two years) or when there has been a change to the current continence regime.

For help completing this form, see the separate notes document.

Coronavirus update

The TAC is unable to send or receive hard copy documents at this time. Please email forms or other documents to and include the client's claim number in the subject line.