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  Assistance.

Please read the following questionaire. If you answer no to any of the questions and think you might like to discuss your eligibility for assistance, please complete and submit the form below and we will contact you.

1: Can you do housework?

2: Can you get to places out of walking distance?

3: Can you go out shopping for groceries or clothes?

4: Can you take your own medicine?

5: Can you handle your own money and pay bills etc?

6: Can you walk without assistance?

7: Can you take a bath or shower without assistance?

8: Do you cook a meal every day?

9: Can you maintain your garden and outside grounds yourself?

10: Can you do your own laundry and peg out your clothes?

11: Can you take out the wheelie bin?

12: Do you see your family and friends often?
 
 

*Your name:


Your date of birth:


Your address:


Your phone number:


*Your email address:

If you have any queries about this survey please call:
Manager: Thea Caffin on (07) 5445 7044.
 
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