Home Care Package Request Form

We will send your client or their representative an information pack if not already provided. Packs are mailed once a week or emailed within 24 business hours.

To commence services: a completed payment authorisation and order request form must be submitted.
Both of these are included in the information pack.

View the 2024/25 Menu
For a print-friendly PDF, scroll to the bottom of the webpage.
Due to systems upgrades, we do not anticipate a new menu release until late 2025.

LGAs serviced*	Available Delivery Days
Ku-ring-gai	Monday to Friday to all suburbs
Hornsby Shire	Mondays, Wednesdays & Fridays Beecroft, Cheltenham, North Epping, Westleigh & Thornleigh Tuesdays only Arcadia, Galston, Fiddletown Dural, Middle Dural, Glenhaven & Glenorie –service not available (outside ACPR service area) Monday to Friday for all remaining suburbs
Northern Beaches	Monday to Friday to serviceable suburbs (generally suburbs north of Curl Curl + Forest District) Clients within the Manly Council electorate (https://en.wikipedia.org/wiki/Electoral_district_of_Manly#/map/0), except those in North Curl Curl and Dee Why, should contact Manly Meals on Wheels for services to be set up.

There are some suburbs that span across two local government areas (LGAs). To provide services, the client must reside in either the Ku-ring-gai, Hornsby or Northern Beaches Council area and the Northern Sydney Aged Care Planning Region (ACPR).

LGA by address can be checked at www.olg.nsw.gov.au/public/find-my-council/
ACPRs can be checked at https://www.gen-agedcaredata.gov.au/resources/access-data/2018/may/aged-care-planning-region-maps

To whom should we send an information pack?

Client's Name

TitleFirst NameSurname

Village Chef Client Status:

Client's Date of Birth

Date

Client's Gender

Client's My Aged Care Number:

Required for government statistical reporting purposes.

Client's Address

Street Address

Suburb

Post Code

Client's Phone Number (preferred)

No spaces. Please include area code for landlines

Client's Phone Number (alternative)

No spaces. Please include area code for landlines

Client's Email Address:

example@example.com

Contact's Name:

Please include first and last

Relationship to Client:

e.g. son, daughter

Select all that apply:

Contact Person's Phone Number (preferred)

No spaces. Please include area code for landlines

Contact Person's Phone Number (alternative)

No spaces. Please include area code for landlines

Contact Person's Email:

example@example.com

e.g. delivery instructions, additional emergency contacts

SAH Price List Effective 1/7/26

SAH/Provider Company Name:

SAH/Provider ABN:

Case Worker's Name:

Please include first name and surname

Case Worker's Direct Phone Number:

No spaces. Please include area code for landlines

Case Worker's Email:

example@example.com

Client Reference Number:

If applicable

Purchase Order Number:

If applicable

Account's Department Email (if different):

example@example.com

Account's Phone Number:

No spaces

I confirm that I have reviewed and agree to the price list above, acknowledging that prices will increase at the start of each new financial year.

I confirm that I have provided the necessary client reference number and/or purchase order number to ensure timely payment of accounts.

I understand that it is my responsibility to advise the client and or representative of out-of-pocket costs.

I understand that the client, in consultation with me/my organisation, is responsible monitoring their assigned budget and expenditure.

If the client has a representative, they are aware that The Village Chef may contact them to provide any necessary setup resources.

I understand that the client and/or their representative is responsible for completing the required paperwork (Order Request Form and Direct Debit Authority) before services can commence. If the service is essential, I acknowledge my role in monitoring its progress and providing assistance.

Signature

Approved By

First NameSurname

Date

Support at Home Package Billing Request Form

LGAs serviced*

Available Delivery Days

Information Pack Requirements

Client Details

Client's Emergency Contact/Representative (if applicable)

Additional Notes/Comments:

Support at Home Provider's Details

Billing Information