Mobile Physio, Dietitian, OT, Drama Therapy and Exercise Physiology Referral Form

Not sure which service you need? Follow this link to understand more about the services we offer: https://southsidephysio.com.au/services/southside-physio/ 

CURRENT WAIT TIMES (regularly updated):

No wait list

Please note that all services referred to through this referral form are MOBILE SERVICES ONLY.

• If you wish to engage in a Physiotherapy, Exercise Physiology or Dietitian service in in the clinic, please contact our Woden or Tuggeranong clinic for an appointment (please see southsidephysio.com.au for clinic contacts or use Clinic Referral Form (snapforms.com.au)

• Please note that Support at Home clients can be seen through our mobile service only

Please select the service(s) you require from the selection below. 

If multiple services are selected, we will arrange a coordinated schedule for you. 

On the spot assessment with recommendation letter

• Up to 1 hour assessment with 15 min of clinical notes 

•  30 min report writing - recommendation letter

Examples include: shower chairs, bath boards, portable raised toilet seats, overbed poles, simple mobility aids, and daily living aids such as reachers or dressing equipment.

E.g.: Rails; Time: 3.25 hours

• Initial assessment at 1 hour and 10 min face to face and 20 min of clinical notes taking to assist with report preparation. 

• 1 hour report writing covering the functional capacity of the resident and scope of works report for the builder. 

• 30 min subsequent consultation with 15 min of clinical notes to document safe effective use of home modification after installation.

E.g.: Wheelchair; Time: 4.83 hours

• Initial assessment at 1 hour and face to face and 20 min of notes taking to assist with report preparation. 

• Up to a maximum of 1.75 (1.5 face to face + 0.25 Clinical notes) hours of face to face AT trial, indirect time and clinical notes 

• 1 hour report writing covering the functional capacity of the resident and recommendations for AT. 

• 30 min subsequent consultation with 15 min of clinical notes to document safe effective use of home modification after installation.

Time: 1.5 hours

Our hourly rate is $230 per hour for therapy and indirect time (ex GST for SAH). 

• We always aim for assessments to be as short as possible and will be no longer than 1 hour and 10 min with 20 min of clinical notes. 

• Following the initials we will seek approval for any further funding based off their needs.
  

* Not all services are able to be covered by Workers Compensation, and each referral will reviewed on a case-by-case basis. Third Party fee schedules are required to match SSPG's fee schedules, including Workers Compensation.

Funding Period Schedule

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Funding Period End

Months

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If you are unsure of the specific home modifications required, we can arrange a 30-minute Care Coordination consultation with one of our Occupational Therapists to provide tailored advice and recommended next steps. 

Note: A 30-minute Care Coordination call will cost $110.00 for Private and Support at Home clients. 

For NDIS clients costing will be in accordance with the current NDIS price guidelines

Straightforward changes with a low risk of major problems arising during or after the work is done. 

Excludes changes to a bathroom floor. 

Don’t require local authority building permission

Budget typicaly $10,000 or less.

Our Occupational Therapy team does not undertake Category B home modifications. 

These modifications include, but are not limited to:

Category B modifications are generally low risk of major problems arising during or after the work is done. 

Don’t require local authority building permission

Budget typicaly between $10,000 and $20,000

Home Modifications: Category B

• Removing a bathtub and installing a walk-in shower with new waterproof flooring 

• Building a medium-sized ramp (5–8 m) with handrails and surface leveling 

• Lowering kitchen benchtops and relocating the sink for wheelchair access 

• Reconfiguring a laundry area, including plumbing and electrical adjustments 

• Widening multiple doorways and replacing door frames (non-load-bearing) 

• Combining several small modifications (e.g., bathroom + ramp + doorway) where total cost exceeds $10,000 AUD

Risks to our team:

These are questions we have to ask to ensure the safety of our team, participants/clients and patients. Please note any risks in the box below. Please consider these questions carefully.

Is there anything you would like to tell us regarding access to your house, parking, etc?

Will the client and the practitioner be the only people present during treatment?

Will all animals be prevented access to the front of the property or the parts where the practitioner will be? If NO, what animals will be present, and do they pose any risk to the practitioner?

Will everyone in the property refrain from smoking, drinking alcohol or using substances during the visit? 

Does anyone in the property have a history of actual or threatened violent/aggressive behaviour?

Are there weapons in the home?

Is there a work area in the property where the practitioner can safely place equipment and work?

Is there stable mobile phone service/coverage? 

Is there any risk of infection or illness? 

Are there any mental health challenges or considerations we need to be aware of?

Are there any behaviour triggers we need to be aware of? If so, is there a behaviour plan in place?

Are there any cultural considerations you would like us to be aware of? 

Are there any other risks we need to be aware of?