Reasonable and Necessary Check

Full Name:

NDIS Number:

Phone:

Email:

Select applicable conditions:

Arthritis

Stroke

Cerebral Palsy

Multiple Sclerosis

Spinal Cord Injury

Other

How does it affect you?

Weak Grip

Tremors

Pain

Reduced Coordination

Vision Impairment

Other

Independence in self-care

Reduce carer reliance

Confidence socially and professionally

Other

How will our grip aid help you?

Do you currently need personal care assistance?

Will this aid help with independence?

Could another system (like Health or Education) fund this?

Why should the NDIS fund this?

Disability-related need

Not a medical device

NDIS funds similar AT

Other

I confirm the information is true and correct.

Hey beautiful 💕
This is your NDIS Reasonable & Necessary form