1/9. Does the care need to start straight away?
Yes, ideally this weekYes, within a fortnightNo, within a monthNo, just researching for the future
2/9. Assuming you choose Daughterly Care to provide the care, will you be paying privately or by a Government Funded Home Care Package?
I will be paying privatelyThe Government will be paying via my Home Care PackageMy Home Care Package and I will be payingWorkers Compensation will be payingInsurance Company will be payingOther (please specify below)
3/9. What is the age of the person to receive the care?
4/9. Is the person to receive the care legally blind?
Yes, legally blindNo, but has poor visionNoI don't know
5/9. Where is the person to receive the care currently?:
in hospitalin rehabilitationin a nursing home on respitein a nursing home and wanting to return to their homeliving at homestaying with an adult child
6/9. What suburb and state does the person to receive the care live in:
State New South WalesVictoriaQueenslandSouth AustraliaWestern AustraliaNorthern TerritoryTasmania
7/9. Enquirer's Name and Contact details:
Your Full Name*
Your relationship to the Elder / Care Recipient*
Your Email* (a copy of this form will be emailed to you)
8/9. What is the main aim of you contacting us?
9/9. How did you find out about Daughterly Care?