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If you or a member of your family is considering Aged Care Accommodation
in the near
future and would like to register interest in the Facility at Ardrossan,
Please Print this page, Fill out the Blank's and return to us via Post or Fax:
Post: 37 Fifth Street, Ardrossan, South Australia, 5571
Fax: ( 08 ) 8837 3677
Name:
Address:
Phone No:
Age:
Current Living Arrangements
(alone, own home, with family, live-in carer)
Do you currently receive support services
(Meals on Wheels, Domiciliary Care, CACP)
ACAT Assessment
( Please Circle )
Yes or No
Name (if referring a family member and in case of emergency)
Name:
Address:
Phone No:
Relationship:
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