Request an Equipment Service

To request assistance please enter your information into the form below. Alternatively, you can download a copy of the Project Request Form and fax or send it in to Solve Disability Solutions Central Office. 

Note: If you are an agent requesting a service on behalf of the client, please make sure the client and/or their carers are informed of the project. They will be receiving information from us in the mail, and it can be confusing if they are not aware of the request.

  1. Client Details

  2. Name*
    Please enter clients name
  3. Address*
    Please enter clients address
  4. Suburb*
    Please enter clients suburb
  5. Postcode*
    Please enter clients postcode
  6. Phone Number
    Please enter clients phone number
  7. Mobile Phone Number
    Invalid Input
  8. Email Address
    Please enter email address
  9. Date of Birth*
    Please enter date of birth
  10. Diagnosis*
    Please enter diagnosis
  11. Invalid Input
  12. Next of Kin Details

  13. Next of Kin
    Invalid Input
  14. Relationship to Client
    Invalid Input
  15. Phone Number
    Please enter clients phone number
  16. Email Address
    Please enter email address
  17. Agent Details

  18. Name
    Please enter clients name
  19. Address
    Please enter clients address
  20. Phone Number
    Please enter clients phone number
  21. Email Address
    Please enter email address
  22. Occupation
    Please enter email address
  23. Project Contact

  24. Main contact for the project*
    Invalid Input
  25. Who is submitting this request?

  26. Requested By*
    Invalid Input
  27. Email Address*
    Please enter email address
    A confirmation email will be sent to this address if your request has been successfully submitted.
  28. If you have selected 'other', please provide the following additional contact details.
  29. Name
    Please enter the requester name
  30. Phone Number
    Please enter the requesters phone number
  31. How did you hear about us?*
    Invalid Input
  32. If 'other', please enter details.
  33. Please enter the requester name
  34. Your Request

  35. Request Details*
    Please enter details of your request
  36. Is project at client's address?*

    Please make a selection
  37. If no, project address is
  38. Is the client aware of this request?*

    Please make a selection
  39. Additional documentation
    Invalid Input
    If you have any additional documentation you would like to include with this request, such as a photo or file, you can upload it here.
  40. NDIS Clients

  41. NDIS Client Number
    Please enter email address
  42. Plan Start Date
  43. Plan End Date
  44. Is this service in your plan?

    Please make a selection
  45. How is this plan being managed?


    Please make a selection
  46. For Managed Plans we require the name of the Plan Manager
    Please enter diagnosis
  47. Upload your NDIS plan
    Invalid Input
    If you have an electronic copy of your current NDIS plan, you can upload your plan here.
  48. TAC Clients

  49. TAC Claim Number
    Please enter email address
  50. TAC Contact Name
    Please enter email address
  51. TAC Contact Phone
    Please enter email address
  52. TAC Contact Email
    Please enter email address
  53. Payment Details

  54. If this project is not being covered by NDIS or TAC, who will be paying for the project?
  55. Payment by client?

    Please make a selection
  56. If no, payment by
  57. Organisation
  58. Address
  59. Phone Number
  60. Email Address
  61. Privacy Statement*
    Please indicate your understanding of this privacy statement by ticking the box!