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. Client Background

  12. The following questions relate to your (or your client’s) cultural, linguistic and religious background. Solve collects this information to ensure we are able to respond effectively and in a culturally appropriate way to our clients’ needs. You may choose not to answer any of these questions. Any information you do provide will be kept confidential.
  13. Are you of Aboriginal or Torres Strait Islander origin?
    Invalid Input
  14. How would you describe your ethnic or cultural heritage (ie. the ancestry that you identify with)?

    Please make a selection
  15. Please enter diagnosis
  16. Are there any cultural or religious requirements that Solve needs to be aware of?

    Please make a selection
  17. Please enter details of your request
  18. Will you require the assistance of a translator?

    Please make a selection
  19. Please enter diagnosis
  20. Next of Kin Details

  21. Next of Kin
    Invalid Input
  22. Relationship to Client
    Invalid Input
  23. Phone Number
    Please enter clients phone number
  24. Email Address
    Please enter email address
  25. Agent Details

  26. Name
    Please enter clients name
  27. Address
    Please enter clients address
  28. Phone Number
    Please enter clients phone number
  29. Email Address
    Please enter email address
  30. Occupation
    Please enter email address
  31. Project Contact

  32. Main contact for the project*
    Invalid Input
  33. Who is submitting this request?

  34. Requested By*
    Invalid Input
  35. Email Address*
    Please enter email address
    A confirmation email will be sent to this address if your request has been successfully submitted.
  36. If you have selected 'other', please provide the following additional contact details.
  37. Name
    Please enter the requester name
  38. Phone Number
    Please enter the requesters phone number
  39. How did you hear about us?*
    Invalid Input
  40. If 'other', please enter details.
  41. Please enter the requester name
  42. Your Request

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

    Please make a selection
  45. If no, project address is
  46. Is the client aware of this request and have they provided consent for the personal information provided on this form to be shared with Solve?*

    Please make a selection
  47. 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.
  48. NDIS Clients

  49. NDIS Client Number
    Please enter email address
  50. Plan Start Date
  51. Plan End Date
  52. Is this service in your plan?

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


    Please make a selection
  54. For Managed Plans we require the name of the Plan Manager
    Please enter diagnosis
  55. Are you registered with SWEP (Statewide Equipment Provider)?

    Please make a selection
  56. Please enter diagnosis
  57. Upload your NDIS plan
    Invalid Input
    If you have an electronic copy of your current NDIS plan, you can upload your plan here.
  58. TAC Clients

  59. TAC Claim Number
    Please enter email address
  60. TAC Contact Name
    Please enter email address
  61. TAC Contact Phone
    Please enter email address
  62. TAC Contact Email
    Please enter email address
  63. Payment Details

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

    Please make a selection
  66. If no, payment by
  67. Organisation
  68. Address
  69. Phone Number
  70. Email Address
  71. Privacy Statement*
    Please indicate your understanding of this privacy statement by ticking the box!

Page updated: 06 July 2017