Get Independence Australia Order Form

Filling out the Independence Australia Order Form online can streamline your ordering process for essential continence products. This guide will walk you through each section of the form, ensuring you complete it accurately and efficiently.

Follow the steps to complete the order form with ease.

1. Click the ‘Get Form’ button to access the order form and open it for filling.
2. Begin by entering the prescriber details. This section requires the name, employer, date, provider number, phone number, email address, and a signature of the authorized prescriber.
3. Next, fill in the entitled person or delivery details. Provide the surname, given names, gender, phone number, customer account number, DVA file number, card type, delivery address, and any specific delivery instructions.
4. Indicate whether the entitled person resides in a Residential Aged Care Facility and if they receive assistance under Home Care Package Level 4. Also, specify if this order is additional or due to a new assessment.
5. In the order section, list the supplier item number, DVA item number, and a description of the continence products. Be sure to include essential details such as brand and size.
6. Specify the quantity of each item being ordered. Remember, orders should typically be limited to a supply of three months unless otherwise specified.
7. Finally, review all entries for accuracy, then save your changes. You can now download, print, or share the completed form as needed.

Complete your order form online today for seamless access to essential continence products.