Seating & Positioning: Referrals

The following forms are required for new referrals to any of the Seating and Positioning Clinics. Please contact the clinic with any questions. Thank you!

Referrals for an evaluation:

  1. Overview of Intake Forms
  2. Consent for Seating and Positioning Services form
  3. New Patient Intake and Medical History form
  4. Seating and Positioning Physician Referral form

Referrals for a repair of equipment fabricated by the Seating and Positioning Clinic:

When a wheelchair needs repairs (frame, headrest, brakes, wheels, etc.), a durable medical equipment (DME) vendor needs to be contacted, since the DME vendor can bill an individual’s insurance for the parts and labor (DIDD cannot bill for parts and labor). For the most part, any DME in the network for the individual’s insurance can be contacted for repairs. If problems are encountered that are difficult to resolve, individuals can contact the clinic for guidance.

When a piece of equipment is delivered through our clinic, we issue a competency form that explains how to help a person into the equipment, how to clean it and who to contact for repairs.  Please review this form and maintain it for reference.

When components of the wheelchair or alternative positioning equipment manufactured by DIDD are in need of repair, the following form should be completed and sent to the clinic.

  1. Repair Referral form

Other Resources:

  1. DIDD Notice of Privacy brochure 
  2. The S&P Clinic Complaint Resolution Policy
  3. Authorization For Release of Protected Health Information
  4. Seating & Positioning Clinic - Process Changes
  5. Title VI Complaint Form