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Assistive Technology Center Referral Form This form should be completed by your physician to make a referral for our Assistive Technology Center. Patient Information Name: Address: City: Home Phone:Date

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How to fill out assistive technology center referral

01

Contact the assistive technology center to schedule an appointment for an assessment.

02

During the appointment, fill out any necessary paperwork provided by the center.

03

Provide information about the individual who will be using the assistive technology, including their needs and preferences.

04

Discuss any relevant medical history or previous experience with assistive technology.

05

Follow any additional instructions or recommendations provided by the center.

Who needs assistive technology center referral?

01

Individuals with disabilities who require assistive technology to help them with daily tasks or communication.

02

Students who need specialized tools or devices to access educational materials and participate in classroom activities.

03

Elderly individuals who could benefit from assistive technology to enhance their independence and quality of life.

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What is assistive technology center referral?

Assistive technology center referral is a process of referring individuals to a center that provides assistive technology services and devices.

Who is required to file assistive technology center referral?

Individuals with disabilities who are in need of assistive technology services and devices are required to file assistive technology center referral.

How to fill out assistive technology center referral?

Assistive technology center referral can be filled out by providing information about the individual's disability, the type of assistive technology needed, and contact information.

What is the purpose of assistive technology center referral?

The purpose of assistive technology center referral is to connect individuals with disabilities to the appropriate services and devices that can help them overcome barriers and improve their quality of life.

What information must be reported on assistive technology center referral?

Information such as the individual's disability diagnosis, specific assistive technology needs, and contact information must be reported on assistive technology center referral.

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