Forms & Referrals – EaseCare Home Care

Forms & Referrals

Whether you're a new client, a health professional, a future team member or want to share feedback — we have a form for you.

Get in Touch

Choose the right form for you

Use the forms below to make an enquiry, refer a client or provide information to help us understand your care needs. Our team will review your details and be in touch shortly.

General Enquiry

For clients, families or carers wanting to learn more about our services.

Full Name *

Phone Number *

Email Address *

Suburb *

Preferred Contact Method

I am enquiring for *

Type of Support Needed

Preferred Start Date

Message / Additional Information

I consent to Easecare Home Care collecting my personal details to respond to this enquiry in accordance with their Privacy Policy.

Your information is kept private and secure.

New Client Intake Form

For people ready to begin services with Easecare Home Care.

Client Details

Client Full Name *

Date of Birth *

Home Address *

Phone Number *

Email Address

Emergency Contact & Representative

Emergency Contact Name *

Emergency Contact Phone *

Relationship to Client

Representative / Nominee Name

Funding & Services

Funding Type *

My Aged Care ID (if applicable)

Services Required *

Personal Care Domestic Assistance Meal Support Transport Social Support Respite Community Access Care Planning

Preferred Days

Mon Tue Wed Thu Fri Sat

Preferred Times

Health & Additional Information

Health Conditions or Mobility Needs

Cultural, Language or Communication Preferences

Pets in the Home?

Access Notes or Risks

I consent to Easecare Home Care collecting and storing this information to arrange and deliver care services in line with their Privacy Policy.

Your information is kept private and secure.

Referral Form

For hospitals, health professionals, support coordinators, families or community organisations.

Referrer Details

Referrer Name *

Organisation

Position / Role

Phone Number *

Email Address *

Client Details

Client Name *

Client Date of Birth *

Client Suburb

Client Phone / Contact

Referral Details

Reason for Referral *

Services Requested

Funding Type

Urgency *

Upload Relevant Documents Click to upload files PDF, DOC or DOCX — max 10 MB each

I confirm I have the client's consent (or appropriate authority) to share their personal information with Easecare Home Care for the purpose of arranging care services.

Your information is kept private and secure.

Feedback & Complaints

Your feedback helps us improve. We welcome compliments, suggestions and complaints.

Your Name *

Phone Number

Email Address

You are a *

Type of Feedback *

Details of Your Feedback *

Preferred Outcome (optional)

I am happy for Easecare Home Care to contact me regarding this feedback.

I consent to Easecare Home Care collecting and storing my details in connection with this feedback submission.

Your information is kept private and secure.

Support Worker Expression of Interest

Interested in joining our care team? Tell us about yourself and we'll be in touch.

Full Name *

Phone Number *

Email Address *

Suburb *

Availability

Weekdays Weekends Mornings Afternoons Evenings Flexible

Relevant Experience

Qualifications

Licences & Checks

Driver's Licence Own Vehicle Police Check First Aid / CPR

Upload Your Resume * Click to upload your resume PDF, DOC or DOCX — max 5 MB

Anything else you'd like us to know?

I consent to Easecare Home Care collecting my details for the purpose of assessing my expression of interest.

Your information is kept private and secure.

Resources

Downloadable Documents

Download and print any of the forms or information sheets below.

Referral Form

For health professionals referring a client to our services.

PDF

New Client Intake Form

Complete this form when you are ready to begin services.

PDF

Service Brochure

An overview of all our home care services.

PDF

Support at Home Information Sheet

Learn about the Support at Home program and how to access it.

PDF

Feedback & Complaints Form

Submit a compliment, complaint or suggestion about our services.

PDF

Privacy Statement

How we collect, store and use your personal information.

PDF

Charter of Aged Care Rights

Your rights as a person receiving aged care services in Australia.

PDF

Client Welcome Pack

Everything you need to know as a new Easecare Home Care client.

PDF

Not sure which form to use?

Our friendly team is happy to guide you. Give us a call or send us a message and we'll point you in the right direction.