Please ensure Javascript is enabled for purposes of website accessibility Application for Residential Aged Care - Garden Village

Application for Residential Aged Care

Thank you for your interest in Garden Village Residential Aged Care. 
Please complete this form for yourself or a family member or download the form to complete and send to us. 

DD slash MM slash YYYY
DD slash MM slash YYYY
Do you need an interpreter?
Support Needs
Do you have any specific cultural requirements?
Are you:
Marital status
Funeral Arrangements
Do you hold an Australian Pension Concession Card?
If yes, indicate the type of pension:
What type of pension do you receive?
If you hold a DVA card, what type is it?
Are you an Australian ex-Prisoner of War?
Do you have a General Practitioner who has agreed to care for you at Garden Village?
Has anyone been appointed on your behalf as an:
Who should we send your monthly statements to?
The following information is required to enable aged care residences to determine whether the resident will be required to pay and Accommodation Payment or Accommodation Contribution. Garden Village suggests you seek independent legal and financial advice. If part of a couple, please complete total assets and income at 50% of the total.
Do you own, or part own, the house, unit or flat in which you normally live?
To determine if your home can be excluded from your assets assessment, please answer the following questions:
Do you have a spouse or dependent child living in your home?
Please indicate
Have you had a carer, who is eligible for a pension or other income support, living in your home for at least the past five years?
Do you own, part own, any other residential or commercial property?
Have you disposed of any property, in which you were living, in the past two years?
Have you any loans to repay?
Do you receive a pension, superannuation or annuity of any type?
DD slash MM slash YYYY
Have you paid an Accommodation Bond or Accommodation Payment Contribution to another residence?
Paid as
DD slash MM slash YYYY
Relationship to resident
Who would you like us to contact regarding this application?
Resident’s Representative (as above)
Application to include (please tick):
Drop files here or
Max. file size: 128 MB.

    Located in Port Macquarie on the NSW Mid North Coast, Garden Village is a leading Retirement Living, Aged Care, Disability and Home Care Service. As a registered not for profit we’ve provided care services to the community for over 40 years.

    For more than 40 years, Garden Village has provided homes, care and support for ageing Australians on the land of the Birpai people. We pay our respects to all First Nations Ancestors, Elders and People in our community and throughout Australia. We acknowledge the Traditional Custodians of Country, and their continuing connection to land, sea, culture and community.

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