1/9. Does the care need to start straight away?
Yes, ideally this weekNo, within a fortnightNo, within a month
2/9. You have decided to use Daughterly Care to provide privately paid care
I will be paying privately, I don't plan to apply for a Government Subsidised Home Care PackageI will be paying privately until my Government funding starts (assigned)I will be paying privately and from a Government Subsidised Home Care Package
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:
Suburb
State New South WalesVictoriaQueenslandSouth AustraliaWestern AustraliaNorthern TerritoryTasmania
7/9. Ideally, what days and times would you like services and briefly what is our role?
8/9. Enquirer's Name and Contact details:
*Mandatory fields
Your Full Name*
Your relationship to the Elder / Care Recipient*
Your Email* (a copy of this form will be emailed to you)
Telephone Number*
9/9. How did you find out about Daughterly Care?
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