Instructions

The Equipment Evaluation Group (EEG) reviews requests for new equipment to be added to the list of devices that can be authorized as communication aids by the Assistive Devices Program (ADP) in Ontario.
The EEG meets twice a year (May and November) to review requests.
If you would like to request a new device for the Individual Authorizer Product Manual please complete the following form.

You must be an Individual Authorizer (OT or SLP) to request equipment evaluation
Fill out information on form below and click to submit request.
If you have questions please email CEP: info@mail.cepp.org

Individual Authorizer Equipment Evaluation Request Form

Date of submission*
MM slash DD slash YYYY
ADP Auth. Number*
IA Name*
First Last
IA Address*
Street Address City Province Postal Code
Phone*
Email*
Employer
Device Information and Rationale
Device Name*
Device Manufacturer*
Device cost (Cd'n $)*
Suggested Device Type*
Indication OT or SLP Authorization
- OT
- SLP
Provide a brief description of product and it's purpose.
List any features that aren't met by other goods in the product manual. Why should this device be added based on your clinical experience?
What experience do you have with this equipment you are requesting?
- Saw it at a conference
- Trialed it with a client / saw a client use it
- Saw it online
- Another clinician told me about it
- Other (please descibe)
Seller / Distributer Information (Ontario Vendor Required)
Name*
Address*
Street Address City Province Postal Code
Phone*
Email*
Phone
This field is for validation purposes and should be left unchanged.

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Instructions

Individual Authorizer Equipment Evaluation Request Form

Device Information and Rationale

Seller / Distributer Information (Ontario Vendor Required)