We’re here to help you navigate the next steps with confidence. Please share a few details so we can ensure the right person from our team reaches out to you.
Who are we looking after today?
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Myself
Someone I care about
Your Name
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First Name
Last Name
Your Email
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example@example.com
Your Phone Number
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Please enter a valid phone number.
Format: 0000000000.
Relationship to participant
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Parent of Participant
Daughter/Son of Participant
Carer
Friend
Other
Participant Details:
Full Name
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First Name
Last Name
Phone Number
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Format: 0000000000.
E-mail
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example@example.com
Participant Location
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Street Address
Street Address Line 2
City
State
Post Code
How would you prefer we contact you?
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Phone Call
Email
Text Message
What is the biggest challenge being experienced right now?
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Reliability (Current support isn't showing up consistently)
Complexity (High-intensity needs requiring extra skill)
System Overwhelm (Need help navigating NDIS/Aged Care)
Feeling Disconnected (Need more community connection)
Access Difficulty (Need to find and connect with specialists)
What is the primary area of support you are exploring?
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Daily Living & In-Home Support
Community Connection
Allied Health (Psychology, OT, Speech)
Nursing (medication support, wound and skin care, chronic illness support etc)
NDIS Navigation and Guidance
I'm not sure, would love to hear what you can offer
Participant age group
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Under 18
Adult
Older person (65+)
How did you hear about us?
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Please Select
Shield of Care Website
Google Search
Word of Mouth
Facebook/Instagram
Please Specify
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Is there already an plan in place?
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Yes, NDIS
Yes, My Aged Care
No, I'm just starting out
Tell us a little more about what you are looking for.
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Tip - Help us understand the story so we can provide the best support.
What's the best time for us to get in touch?
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Morning
Afternoon
Evening
Anytime
Would you like to book your free 20-minute Support Consultation now?
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Yes, show me the calendar
No, please contact me first
Is there anything else you'd like to ask or share right now?
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