Strength for life forms

Strength for life participant information

If you wish to join the Strength for Life program in Darwin, you can download the forms that you will require below. The enrolment form and pre activity questionnaire are compulsory; if you answer yes to any questions on the Pre Activity Questionnaire, also download the medical referral form.

To Enrol in a Strength for life program you will require:

• Enrolment Form
• Pre Activity Questionnaire

If you answer yes to any questions on the pre-activity questionnaire, you will also need the medical referral form to be completed by your Doctor. 

If you have had recent treatment with a physiotherapist for a musculoskeletal issue, you can take the allied health form to the physio for completion before you attend your assessment.

When all of your forms are completed contact COTA NT, please send them to the local Strength for Life program co-ordinator and contact them for an assessment date and time. You will need to take all your forms with you to your initial assessment.

Click the links below to download forms:

Tier 1 Forms

• Enrolment Form (tier 1)
• Pre-activity Readiness Questionnaire
• Medical Referral Form (tier 1)
• aAllied Health Referral Form

Tier 2 Forms

• Enrolment Form (tier2)
• Pre-activity Readiness Questionnaire
• Medical Referral Form (tier 2)
• Physio Referral Form

Health Fund forms

• AHM Health Improvement Benefits Approval
• BUPA Living Well Programs Approval Form
• Health Partners Health Management Approval Form
• Medibank Approval Form Health Management Program
• HCF Exercise and Gym Benefits Authorisation and Claim

Participant Survey

• Strength for Life Participant Survey

This program is part of a parent STRENGTH FOR LIFE scheme operated by COTA SA.