Louisiana Tech University
Center for Biomedical Engineering and Rehabilitation Sciences

Download Referral Forms for Assistive Technology Services

Assessment Service	Required Forms for a Complete Referral (To download Right Click, select "Save Target as" or "Save Link as")
Assistive Devices for Independent Living More about ADL Evaluations Referral Procedures	Referral Form.pdf History and Current Status Form.pdf Assistive Devices For Independent Living Pre-Admission Screening.pdf * All ADL Referral Forms in One  File Download
Augmentative / Alternative Communication More about AAC Evaluations Referral Procedures	Referral Form.pdf History and Current Status Form.pdf Communication History and Current Status Form.pdf * All AAC Referral forms in One File Download
Computer Access More about Computer Access Evaluations	Referral Form.pdf History and Current Status Form.pdf Computer Access Program Pre-Admission Screening.pdf * All Computer Access Referral forms in One File Download
Personal Transportation: More about Driving Assessment Evaluations Referral Procedures
Driving Assessment	Referral Form.pdf History and Current Status Form.pdf Driver Pre-Assessment Form.pdf Driver-Consumer Agreement and Consent Form.pdf Office of Motor Vehicles Medical Examination Form.pdf Vehicle Information.pdf * All Driving Assessment Referral forms in One File Download
Personal Transportation (For Non-Driving Transportation Evaluations Only)	Referral Form.pdf History and Current Status Form.pdf Vehicle Information.pdf * All Personal Transportation Only Referral forms in One File Download
Rehabilitation Engineering: More about Rehabilitation Engineering Evaluations Referral Procedures
Home Assessment	Referral Form.pdf History and Current Status Form.pdf * All Home Assessment Referral forms in One File Download
Worksite Assessment	Referral Form.pdf History and Current Status Form.pdf * All Worksite Assessment Referral forms in One File Download
Seating and Wheeled Mobility More about Seating and Wheeled Mobility Evaluations Referral Procedures	Referral Form.pdf History and Current Status Form.pdf Seating & Positioning History and Current History Form.pdf * All Seating and Wheeled Mobility Referral forms in One File Download

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