1. Initial Enquiry Form

Initial Enquiry Form

Please complete this form to submit a residential aged care initial enquiry with us.
Date

DayMonthYear
Date
Name*

First NameLast Name
Contact Email address*
example@example.com
Mobile*
Please enter a valid phone number.
Are you a Veteran?

YesNo
Service Record

ArmyNavyAir ForceOther
Service Number
Rank:
Unit:
Any other relevant veteran or war widow information?
Seeking type of Care

Respite to PermanentRespite Only

Do you have approvals through My Aged Care for Respite and/or Permanent Residential Care?*

YesNo
MAC Permanent Referral Code - please provide
MAC Respite Referral Code - please provide
Do you receive the Aged Care Pension?*

YesNo
** The following is IMPORTANT to understand and ensure you have in place. **
Has a Residential Aged Care - Calculation of cost of Care SA457 or SA485 form been submitted to Services Australia/DVA?*

YesNo
Please provide Claim ID number
Admission into Residential Aged Care is dependent on being assessed through My Aged Care for Respite or Permanent Residential Care, as well as a Calculation of your Cost of Care through Services Australia/Centrelink.

If you DO receive the Aged Care Pension or DVA entitlements, AND have not applied for the Calculation of your cost of care for Residential Care through Services Australia/Centrelink, you will need to apply here.
Form SA485 - if you DO receive means tested income support or DVA payments
Admission into Residential Aged Care is dependent on being assessed through My Aged Care for Respite or Permanent Residential Care, as well as a Calculation of your Cost of Care through Services Australia/Centrelink.

If you DO NOT receive the Aged Care Pension or DVA entitlements, AND have not applied for the Calculation of your cost of care for Residential Care through Services Australia/Centrelink, you will need to apply here.
Form SA457 - if you DO NOT receive means tested income support or DVA payments
Should be Empty:

Initial Enquiry Form