Application for Residential Aged Care

Download a printable application form

Applicant information
Applicant’s representative
Pension and benefit details
Medicare details
Health insurance details
Ambulance cover
Civic duty
Medical details

If yes, it is essential that your doctor agrees to visit you at TLC Aged Care or provide a locum service to you, outside of normal business hours, in the event of illness or injury.

If no, there are doctors who routinely visit TLC Aged Care residences. You may choose to have one of these doctors as your nominated Medical Practitioner.

Please provide your current General Practitioner’s details:

Pharmacy details

If yes, please provide your pharmacy details below.

Emergency contact 1
Emergency contact 2
Previous aged care residential accommodation details

If yes, please provide the following details:

Click here for details of the TLC Aged Care privacy policy.