Application for Residential Aged Care

Download a printable application form

Applicant information

Please note that Gold Privileges memberships may be applicable to areas of some TLC homes; please ask our Resident Liaison for further information.

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

TLC Aged Care homes are co-located with a medical centre. TLC Primary Care’s on-site General practitioners are available if you would like them to provide your care. If you do not wish to receive care from our general practitioners please complete this section.

Please provide your current General Practitioner’s details:

Pharmacy details

TLC Aged Care is able to provide you with information about pharmacy services. If you do not wish to receive your medications from our pharmacy provider please complete this section.

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.