I am enquiring for
*
Myself
On behalf of someone else
Reason for enquiry
*
Approved HCP: searching for a provider
Assigned HCP: searching for a provider
CHSP funded: looking for service availability
Have current services and enquiring about others
Information gathering about aged care services
Mind+Move
Respite HCS
Residential Aged Care
Retirement Living
Seeking to change provider
Home Care
Tell us more
*
Postcode where services would be required
*
Your Details:
First Name
*
Last Name
*
Mobile
*
Landline
Email
*
My Details:
Care Recipient Details:
First Name
*
Last Name
*
Mobile
Landline
Please provide a phone number so we can give you a call back *
Email
Has the Care Recipient registered for Government funding at myagedcare.com.au? (Tick if YES)
1_Lead Channel
Phone
MAC Provider Portal
Email
Walk-in or Event Attendee
Web Enquiry Form
1_Random Email
How did you hear about us?
*
Church/Parish
Digital (Google, Facebook, Website, YouTube)
Local event
Ageing Well Series
Print (Newspaper, Magazine)
Direct Mail (Letter, Flyer)
Outdoor (Billboard, Vehicle, Bus Stop)
Radio
My Aged Care
Word of mouth
Yes
No
Aged Care Service Provider
CHL staff/volunteer
Church/Parish
Clergy and Religious
Community Housing
Digital (Google, Facebook, Website, YouTube)
Direct Mail (Letter, Flyer)
Event
Existing Customer
Health professional
Lendlease
Hospital
MAC Provider Portal
Marketing Campaign
My Aged Care
Outdoor (Billboard, Vehicle, Bus Stop)
Print (Newspaper, Magazine)
RAC
Radio
RAS/ACAT assessors
Retirement Living
Television
Third Party Listing (Aged Care Guide)
Word of mouth
Yes! I would like to receive updates about products & services, promotions, news and events from Catholic Healthcare via mail, email and/or sms.