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Direct Order Form - Thickeners - DVA 2026
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- Click ‘Get Form’ to open the Direct Order Form - Thickeners - DVA in the editor.
- Begin by filling in the 'Provider details' section. Enter the name, address, postcode, provider number, phone number, email address, and signature of the speech pathologist or GP/LMO.
- Next, complete the 'Client delivery details' section. Input the client's surname, given names, date of birth, phone number, customer account number (if applicable), DVA file number, and card type.
- Specify the delivery address and any special delivery instructions. If applicable, include a prior approval number for White Card holders.
- In the 'Recommendations' section, list the item and level of thickness required along with the quantity needed per month and daily usage.
- Finally, provide clinical details including medical diagnosis and follow-up plans. Ensure all information is accurate before submitting.
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