Use these forms to arrange treatment and support services for veterans and their dependents who have DVA health cards.

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Most often used

Form ID Form name Who can use this form Updated Download
D0992 D0992 - Mobility Functional Support (MFS) products order form For providers, General Practitioner, Hospitals & day procedure centres, Medical specialist, Occupational therapist (general), Physiotherapist, Rehabilitation service provider, Registered Nurse, Exercise physiologist, Podiatrist, Orthotist, Prosthetist 3 April 2025 Download as PDF (120.17 KB)
D0904 D0904 - DVA request/referral voucher For providers, General Practitioner 3 April 2025 Download as PDF (143.53 KB)
D9132 Dose Administration Aid (DAA) service VSMR For providers, Pharmacist 3 April 2025 Download as PDF (305.76 KB)
D9300 D9300 - Electric Mobility Aids - Part 1 - Medical Assessment For providers, General Practitioner 3 April 2025 Download as PDF (168.96 KB)
D0988 D0988 – Continence direct order form For providers, General Practitioner, Medical specialist, Occupational therapist (general), Occupational therapist (mental health), Physiotherapist, Registered Nurse 3 April 2025 Download as PDF (164.89 KB)

All forms

Form ID Form name Who can use this form Updated Download
D9160 D9160 - Request for Trial of Equipment (Exercise Bike/Knee Scooter) - 3 Months Only For providers, Chiropractor, Exercise physiologist, General Practitioner, Medical specialist, Osteopath, Physiotherapist Download as PDF (185.89 KB)
D9199 D9199 - Assessment form for the supply of a Personal Response System For providers, General Practitioner, Medical specialist, Occupational therapist (general), Physiotherapist, Registered Nurse Download as PDF (238.56 KB)
D9257 D9257 - Order form for low vision products For providers, Low Vision Clinic, Occupational therapist (general), Optometrist, Orthoptist and Optical dispenser, Medical specialist Download as PDF (135.69 KB)
D9299 D9299 - Post Home Modification Report For providers, Occupational therapist (general) Download as PDF (182.21 KB)
D9300 D9300 - Electric Mobility Aids - Part 1 - Medical Assessment For providers, General Practitioner Download as PDF (168.96 KB)
D9356 D9356 - Request for an assistance dog For providers, Clinical psychologist, Medical specialist, Neuropsychologist, Occupational therapist (general), Occupational therapist (mental health), Psychologist, Social worker (mental health) Download as PDF (332.87 KB)
D9376 D9376 - Request for assistive listening devices and/or tinnitus devices For providers, Audiologist, General Practitioner, Hospitals & day procedure centres, Rehabilitation service provider, General Download as PDF (140.56 KB)
D9379 D9379 - Electric Mobility Aids - Part 3 - Trial For providers, Occupational therapist (general) Download as PDF (277.47 KB)
D9381 D9381 - Authority to Install/Modify - Vehicle Modifications For providers, Occupational therapist (general) Download as PDF (143.47 KB)
D9414 D9414 - Order Form Diabetes Products General Practitioner, Diabetes educator, Diabetes Clinic, Endocrinologist, Registered Nurse, Specialist (includes all medical specialists in relevant field), For providers Download as PDF (107.67 KB)
D9517 D9517 - Driver Assessment and Training / Vehicle Modifications - Medical Information Form For providers, Occupational therapist (general), General Practitioner, Local Medical Officer Download as PDF (155.72 KB)
D0986 Dental Request for Prior Approval for Treatment or Referral to a Specialist For providers, Dental prosthetist, Dental specialist, Dentist, Medical specialist Download as PDF (251.57 KB)
D9287 Diagnosis Form For providers Download as PDF (134.88 KB)
D0653A Discharge Advice and Hospital Claim For providers, Hospitals & day procedure centres Download as PDF (137.78 KB)
D9416 Disfigurement and Social Impairment Compensation, For providers Download as DOCX (2.13 MB)
D9416 Disfigurement and Social Impairment Compensation, For providers Download as PDF (257.95 KB)
D9449 Disorders of the Colorectum and Anus Compensation, For providers Download as PDF (273.99 KB)
D9449 Disorders of the Colorectum and Anus Compensation, For providers Download as DOCX (69.83 KB)
D9132 Dose Administration Aid (DAA) service VSMR For providers, Pharmacist Download as PDF (305.76 KB)
D9417 Ear Condition(s) Compensation, For providers Download as PDF (199.06 KB)
D9417 Ear Condition(s) Compensation, For providers Download as DOCX (1.54 MB)
D9471 Ear, Nose and Throat Condition(s) - (DRCA) Compensation (DRCA), Compensation, For providers Download as DOCX (72.25 KB)
D9471 Ear, Nose and Throat Condition(s) - (DRCA) Compensation (DRCA), Compensation, For providers Download as PDF (325.22 KB)
D9438 Elbow Condition(s) Compensation, For providers Download as PDF (270.64 KB)
D9438 Elbow Condition(s) Compensation, For providers Download as DOCX (68.06 KB)