Prospective Resident Information Title Gender Do you need an interpreter? Support Needs Pension and Benefits Do you have any specific cultural requirements? Are you: Marital status Funeral Arrangements Resident’s Personal Information 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? Medical Do you have a General Practitioner who has agreed to care for you at Garden Village? Please note: It is essential that your General Practitioner agrees to visit you at Garden Village or provides a locum service, outside of normal business hours, in the event of illness or injury.
There are General Practitioners who routinely visit Garden Village who can be our nominated Medical Practitioner. We can provide you with their information. Legal and Financial Management Has anyone been appointed on your behalf as an: Who should we send your monthly statements to? Asset and Income Details
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? Other assets: Do you receive a pension, superannuation or annuity of any type? Prospective Resident’s Representative Have you paid an Accommodation Bond or Accommodation Payment Contribution to another residence? Paid as Previous Aged Care Experience Relationship to resident Who would you like us to contact regarding this application? Next of Kin or Emergency Contacts First contact Resident’s Representative (as above) Second contact Third contact Application to include (please tick): File Uploads
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