Personal Home Care - Information form

  • How can we help?

    Welcome to PHC. We are committed to supporting you where we can. Please complete this form to give us some understanding of your needs. Your answers will guide us in how we can help you and we will be in contact as soon as we can.
  • Do you wish to receive care from PHC*

  • Your Details

    Tell us about yourself and how we can contact you.
  • Format: (000) 000-0000.

  • Care Requirements

    Please provide details about the person who will receive care.
  • Who is the care for?
  • Main care needs (select all that apply)

  • Care Needs & Schedule

    Help us understand the type and schedule of care required.
  • What kind of care duration do you need?
  • When would you like care to start
  • Days of the week when care is needed
  • May overnight care be needed?
  • Are you currently receiving support through ACC?
  • Are you currently receiving support through ACC?
  • Do you have an ACC claim number available?
  • Do you have an ACC Recovery Partner / Case Manager?
  • Would you like us to speak with your ACC recovery partner if needed?
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  • Click the image abover for our complete costs and services.  It's comprehensive, so if you want to talk through any questions you may have, feel free to call us 027 343 4776. If you are wanting care urgently, call or email on phc.admin@phcare.co.nz to let us know you accept the costs and services and we can arrange a nurse to visit you immediately. We understand everyone's needs are different, so I look forward to hearing about your situation. With my kind team, we will try to find a supportive solution for you.

    Sarah Holmes

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