Home services needs assessment referral form (for Provider use only)

Summary:

For medical and health providers – complete this form when requesting an occupational therapist assessment of the functional capacity and needs of clients who are unable to perform their usual household duties and responsibilities due to their transport accident injuries.

Coronavirus update

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