Equipment2018-05-09T04:18:27+00:00

ENHANCING QUALITY OF LIFE

As a priority of Save Our Sons Duchenne Foundation, we aim to improve the quality of life for those in all stages of Duchenne.
We help families afford essential quality of life equipment not currently available under State/Federal Government funding schemes including:

  • Cough assist machines that help with coughing when the chest muscles are too weak to effectively clear secretions from the lungs
  • Breathing machines (sip and puff mouthpiece ventilation)
  • Swim scooters (SeaDoo)
  • Mobility scooters
  • Stand-up wheelchairs

Our Enhancing Quality Of Life, equipment program is made possible through the generosity of our National Partner Chemist Warehouse, Fundraising and donations from our supporters.
Together we can make a difference – Donate today to help Save Our Sons’ give back a little of what Duchenne has taken away by supporting our Enhancing Children’s Quality of Life Program today.

DONATE NOW

ENHANCING QUALITY OF LIFE

As a priority of Save Our Sons Duchenne Foundation, we aim to improve the quality of life for those in all stages of Duchenne.
We help families afford essential quality of life equipment not currently available under State/Federal Government funding schemes including:

  • Cough assist machines that help with coughing when the chest muscles are too weak to effectively clear secretions from the lungs
  • Breathing machines (sip and puff mouthpiece ventilation)
  • Swim scooters (SeaDoo)
  • Mobility scooters
  • Stand-up wheelchairs

Our Enhancing Quality Of Life, equipment program is made possible through the generosity of our National Partner Chemist Warehouse, Fundraising and donations from our supporters.
Together we can make a difference – Donate today to help Save Our Sons’ give back a little of what Duchenne has taken away by supporting our Enhancing Children’s Quality of Life Program today.

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Enhancing Quality of Life (EQOL)
Equipment Funding Application For Save Our Sons Duchenne Foundation

Name of Applicant

Relationship to Beneficiary

Address

Post Code

Contact
Mobile
Home

Please confirm that the equipment is requested for a person with Duchenne or Becker muscular dystrophy only. Please specify (please note that Save Our Sons does not provide funding for allied conditions)
DuchenneBecker

Name of Beneficiary

Address

Date of birth

Male or Female

Aboriginal or Torres Strait Islander?
YesNo

Is an Australian citizen or has residency?
YesNo

Equipment requested
Sip mouth piece ventilation - This is supplied directly from Phillips and quote is not neededCough assist machine - This is supplied directly from Phillips and quote is not neededStanding wheelchair - Please attach an itemised, client specific, written quoteMobility scooters – Please supply quoteSwim scooters - This is supplied directly from Seadoo and quote is not required.Wheelchair additions and upgrades – Please attach an itemised, client specific, written quote

Grant amount requested

Details of the Allied Health Professional who is recognised for prescription of the specific item (ie occupational therapist, physiotherapist, specialist nurse, neurologist or other medical specialist), who is able to confirm the beneficiary’s, need and suitability of the item requested.

Name

Position

Qualifications / Membership of Professional Association number

Place of Work

Contact
Mobile
Home

Email

Availability
When is the best time to contact you?

What provision, if any, has been made for the MOU?

Please attach 2 itemised, client-specific, written quotes. If only one quote supplied, please provide an explanation why. Eg: sole supplier. (Limit:10mb/file)

It is expected that the preferred quote will be for the lower price unless there are particular reasons to do otherwise. Where the more expensive quote is preferred, a sound clinical rationale must be provided to support this decision.

Supplier
Total cost
Quotation Number

Please describe how this will benefit the individual and /or primary carer

Please provide any additional information you feel may benefit your application

Proposed Funding Sources

Total cost of equipment

Amount funded by other sources (please list i.e. Government)

Contribution by individual / family

Does the individual / family have a Trust Fund for condition related expenses? (This in no way makes you ineligible for funding – further information may be requested) How much will be allocated from the Trust Fund?

Have you fundraised to assist with the purchase of this equipment e.g. held a fundraiser / raffle, used crowd funding etc?
YesNo

Please provide evidence of applications to third-party funders such as Variety.
Reference number of application or reference person contacted.

Funding amount requested from Save Our Sons Inc?

Note: If you have any problems submitting this form, please email klair@saveoursons.org.au