Customisations
Form

Customisations are changes to the structure, layout or fittings of a participant's home so they safely access it and move around comfortably in areas they frequently use.

In Sana Living homes, requests for Customisations must be prescribed by a qualified Occupational Therapist following an assessment of the property. Customisations must be approved by Sana Living before any changes are made to the structure of the premises. Sana Living will coordinate the quote and works required following acceptance of the quote.

Please utilise the format of this form to specify/prescribe customisations required by the participant.

NB: Requests are made with reference to Clause 6.4 Maintenance and Repair of the Licence to Occupy.
Please note that any customisations undertaken in your home will need to be 'made good' at your cost at the cessation of your lease. This includes customisations funded through your NDIS plan.

Participant Details
Customisation Request
Location / Area
Description of Works
Clinical Justification(if applicable)
Proposed Payment Method:
 Other: 
Customisation Request #2
Location / Area
Description of Works
Clinical Justification(if applicable)
Proposed Payment Method:
 Other: 
Customisation Request #3
Location / Area
Description of Works
Clinical Justification(if applicable)
Proposed Payment Method:
 Other: 
Once complete, use Save / Print as PDF below,
then email the saved PDF to:
customisations@sanaliving.com.au
Declaration
  • I confirm that I have reviewed the recommendations and clinical evidence provided by my Occupational Therapist (if applicable).
  • I agree and approve the proposed customisations suit my individual needs.

By typing your full name above you are applying your digital signature to this form.

By typing your full name above you are applying your digital signature to this form.

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