Application for Funding Mobility Devices

Used to apply for Funding for Communication Aids

For Specialist physician & ADP registered authorizers to request funding for extraoral (facial) prostheses.

For Specialist physician & ADP registered authorizer to request funding for intraoral (mouth) prostheses.

Used to apply for Funding for Respiratory Equipment & Supplies

Used by clients to apply for funding for a silicone breast prosthesis(es)

Used by Amputee Team, registered with ADP to request funding for conventional upper/lower limb prosthees.

Used to renew funding for home oxygen therapy.

Used to apply for Funding for Ventilator Equipment and Supplies

This form is used by Manufacturer's Testing Facilities to report testing of Manual Wheelchairs.

This form is used by Manufacturer's Testing Facilities to report testing of Ambulation Aids

Used by senior clients, 65 years and older, who are on daily insulin injections to apply for funding for syringes.

To be used for all applications for Home Oxygen Therapy funding.

Used to apply for Funding for Enteral Feeding Pump and Supplies

Application used to determine elegibility for funding by ADP for insulin pumps and supplies

This form is used by Manufacturers to report testing of Powered Mobility Devices

The Vendor Registration Application form is an interactive form that will be completed by an Ontario retailer or supplier of assistive devices who is requesting registration with the Assistive Devices Program.

Addendum for Ventilator Equipment and Supplies Application

The Vendor Registration Application form is an interactive form that will be completed by an Ontario retailer or supplier of home oxygen therapy who is requesting registration with the Assistive Devices Program.

This form is used by manufacturers/distributors of mobility equipment (wheelchairs and wheeled walkers) for the purpose of making application to the Assistive Devices Program requesting approval to list their respective products on the list of approved devices.