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Accredited Support At Home Provider
Perth (08) 6146 6296
Melbourne (03) 9969 0300
Geraldton (08) 6182 1703
NDIS
Support At Home
Email
Referral
Home
About
About My Way Support At Home
New Clients
Transitional Clients
Grandfathered Clients
Support At Home Levels
Assistive Technology and Mobility Aids
The Statement of Rights and Principles
Code of Conduct
Services
Clinical Care
Independence Care
Everyday Living Help
Transfer to My Way
Fees
Contact
Contact My Way
Feedback
Risk Report
Home
About
About My Way Support At Home
New Clients
Transitional Clients
Grandfathered Clients
Support At Home Levels
Assistive Technology and Mobility Aids
The Statement of Rights and Principles
Code of Conduct
Services
Clinical Care
Independence Care
Everyday Living Help
Transfer to My Way
Fees
Contact
Contact My Way
Feedback
Risk Report
Referral
Support At Home Referral
Fill in Online
Download PDF
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1
Aged Care Funding Information
2
Consumer’s Details
3
Referrer’s Details
Aged Care Funding Information
Referral Code:
Aged Care ID Number:
Is this a transition from another provider?
Yes
No
Start date of Aged Care Plan:
When did your Home Care Package get approved?
Before Sept 12, 2024
Sept 12, 2024 – Oct 31, 2025
From Nov 1, 2025
Funding
Government Funded Home Care & Flexible Care
Self-Managed
Other
Required Services
Required Services
Clinical Care
Independence Support
Everyday Living Help
Support at Home Classification
Classification 1
Classification 2
Classification 3
Classification 4
Classification 5
Classification 6
Classification 7
Classification 8
Contact Details for Invoices (If applicable):
Name
First
Last
Contact Number
Email
Consumer’s Details
Name
First
Last
Date of Birth
Gender
Medicare Card
Medicare Individual Reference Number (IRN)
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Consumer Email
Consumer Phone Number
Alternative Contact Name
First
Last
Alternative Contact Phone Number
Alternative Contact Email
Language
Preferred Language Spoken
Interpreter Required?
Yes
No
Sign Language Required?
Yes
No
Preferred Method of Communication
Face-to-face
Phone Call
Text Message
Email
Letter
Visual (images/video)
Contact with the Representative
Closest Branch
CARNARVON WA
GERALDTON WA
GIRRAWHEEN WA
GOSNELLS WA
JOONDALUP WA
MANDURAH WA
MIDLAND WA
OSBORNE PARK WA
ROCKINGHAM WA
DANDENONG VIC
DEER PARK VIC
WERRIBEE VIC
TENNANT CREEK NT
NOT SURE
Consumer’s Background
Country of Birth
Is the consumer of Aboriginal or Torres Strait Islander origin?
Aboriginal
Torres Strait Islander
Neither
Both
Is the consumer a refugee or asylum seeker?
Refugee
Asylum Seeker
Neither
Referrer’s Details
Referrer Name
First
Last
Referrer Phone Number
Referrer Email
Home
About
About My Way Support At Home
New Clients
Transitional Clients
Grandfathered Clients
Support At Home Levels
Assistive Technology and Mobility Aids
The Statement of Rights and Principles
Code of Conduct
Services
Clinical Care
Independence Care
Everyday Living Help
Transfer to My Way
Fees
Contact
Contact My Way
Feedback
Risk Report
Email
Referral
NDIS
Support At Home
