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Accredited Support At Home Provider

Perth (08) 6146 6296

Melbourne (03) 9969 0300

Geraldton (08) 6182 1703

Support At Home

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Home
About
Services
Transfer to My Way
Fees
Contact

Support At Home Referral

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1Aged Care Funding Information

2Consumer’s Details

3Referrer’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

Our Head Office is open from
9:00am to 5:00pm, Monday to Friday.

Closed on public holidays.

Please contact head office prior to visiting our branch sites.

NDIS ID: 4050044379
ABN: 24 574 460 703

REMITTANCES

Please send all remittances to remittance@myway.org.au

Perth: (08) 6146 6296

Carnarvon: (08) 6285 3970

Geraldton: (08) 6182 1703

Melbourne: (03) 9969 0300

Tennant Creek: 0413 780 792

admin@myway.org.au

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Our Locations

Western Australia

Mandurah (Anzac Pl)

Mandurah (Mandurah Tce)

Victoria

Northern Territory

My Way Group - Service Links

Support at Home
Disability Home and Living Support
Home Nursing
NDIS Plan Management
NDIS Support Coordination
Psychosocial Recovery Coaching
Occupational Therapy
Positive Behaviour Support
PBS Impact Statements
Restrictive Practices
Physiotherapy
SIL Housing
Speech Therapy

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Home
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Support At Home

A mud map of how to get to My Way's Rockingham branch