Major Modifications Referral Form

Please note to be eligible for CHSP Home Modifications funding consumers need to be registered and have a My Aged Care Referral Code for Home Modifications.

Please advise consumer to contact My Aged Care (1800 200 422) if they do not have a Home Modifications Referral Code and contact Home Assist Community Services on (07) 4123 2234 with their Code so we can assist them with CHSP funding and avoid delays.

Private Residence (Client or Family Owned/Purchasing)Private RentalPublic RentalIndependent Living Unit

YesNoPlease send calendar invitation and OT will attend if available

Please be advised Builders will need to be QBCC Registered, have public liability insurance, police check and be willing to become registered with Home Assist Community Services.

*Please note - Video Assessment and OT Proforma are no longer a requirement.

(this is requested, so the budget can be taken into consideration in the design)

YesNoPlease send calendar invitation and OT will attend if available

Major Modifications Referral Form

If you require items to be quoted separately please submit separate referrals for each item.

Consumer Details