Alterations form *Please note there will be a fee applied - please click here to view our fee schedule. Name Date of birth Please enter your date of birth in dd/mm/yyyy format (eg 2nd March 1973 as 02/03/1973). Address Phone number Please provide your phone number, so we can contact you if needed. Email address What alterations would you like to make to your home? Have any of the alterations been recommended by an occupational therapist or health professional? Yes No Please provide details Is there a medical need for the alteration? Yes No Please provide details
