Prosthetic Limb Services (PLS)
Please note, our Equipment Request Forms (ERF) currently do not fully meet the NSW Government accessibility guidelines. We are working towards correcting this, to ensure there are no barriers to completing our forms. We will update the website when they are ready. Please avoid saving ERFs locally and always download them from this page when you need them.
The following Prosthetic Limb Services (PLS) forms and clinical criteria are available for general use:
Funding criteria
Equipment request forms
- Discretionary form - upper & lower limb form
- Minor repair voucher for use by Prosthetic Service Providers
- Prosthesis Major Repair Request Form
- Prosthesis Interim Primary Replacement Equipment Request Form
Accreditation guidelines
Components list
EnableNSW funds a wide range of prosthetic components for use in prosthetic limbs. For more information about components on the list and whether they are suitable for you, we recommend that you speak with your Prosthetic Service Provider.