Useful Forms

New WAOA Member Form

Complete this form with your Stomal Therapy Nurse

Monthly Appliance Order Form

Ensure you have sufficient products and order what you need 14 days before you need it.

Download PDF Order Online Now

PBS Stoma Appliance Scheme Application Form

To be completed by Medical Officers and Stomal Therapy Nurses and signed by the Applicant.

SAS Application for Additional Stoma Supplies

To be completed by Medical Officers and Stomal Therapy Nurses

Irrigation Kit Authorisation Form

To be completed by Medical Officers and Stomal Therapy Nurses

Tieman Tip Catheters Authorisation Form

To be completed by Medical Officers and Stomal Therapy Nurses

Deodorant and Absorption Gelling Sachets Authorisation Form

To be completed by Medical Officers and Stomal Therapy Nurses

Orders may be submitted by email to [email protected] using the order form linked above.
Please include your membership number, name, address, item numbers and quantities of the products you require and indicate if the order is to be shipped or collected from the distribution centre.

Alternatively the orders can be posted to

Postal Address: PO Box 706 Mt Lawley WA 6929

Please allow up to 14 days for processing and delivery.

Instructions On PDF Forms

You may complete these forms either digitally or manually.

Once the PDF form(s) has been completed you can return to us via:

Email: [email protected]
Post: PO BOX 706 MT Lawley WA 6929
Fax: (08) 9271 4605

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