Please contact us for information on services in your area.
Do you have a parent or a family member who you think would benefit with some help around the house?
How about a Care Voucher?
My Health Carers also support the EACH, EACH DEMENTIA, CAPS, National Carer Respite program, ISP, TAC and Workcover programs
Attention
Service Provider
My Health Carers
Phone
9783 7099
Fax
9783 7299
Client Name
D.O.B.
Address 1
Address 2
Town
State
Postcode
Contact Person or Carer
Care Manager/Carer
Commencement Date
Name
Address
Service Required IN HOME CARE MAINTENANCE BOTH
Do you wish to use one of our packages? Bronze Silver Gold My Care Plan Maintenance Package
Medical History and Special Requirements?
Has the home been OH&S assessed? Yes No
Is there a Care Plan in place? Yes No
If yes, has a copy been faxed to the office? Yes No
Is there a Key Safe? Yes No
Keysafe Number
Keysafe Location
Are any mobility/walking aids used? Yes No
Type of Walking Aids / Comments?
Is there any other information the carers would benefit from knowing?
Tasks
Is this a permanent/ongoing shift? Yes No
Duration / Time Allocated? HRS (minimum of 1.5 hours for gardening)
Recurrence / How often? Every weeks
The maintenance worker will make contact to arrange day, time etc. Who is the contact? Care Manager Client Contact Person or Carer
When you submit your Request Form, it will be emailed directly to My Health Carers for processing. If required, someone will get back to you shortly.