There are 3 options for this form.  Fill in online, download the pdf and fill in on the computer (it has fillable fields) or download and fill in with a pen.

Download and fill in using a pdf application. Once this has been completed, email back to us.

Download and print out. Once this has been completed, scan and email or post back to us.

Step 1 of 7

Application for admission to residential care

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❖This form is required to be completed and returned to Bedingfeld Park Inc for admission toBedingfeld Lodge.
❖The information you provide in this form is information that a residential care service wouldnormally require to assess and meet your needs and to meet Government Requirements.
❖You should consult Bedingfeld Park Inc directly for information about how your privacy isprotected.
❖Please use black pen, in clear legible letters and where indicated, tick the box or write acomment as requested.

Care being sought:

Care being sought:

You need to provide:

A current ACAR Assessment form or Support Plan referral code
(Contact My Aged Care to obtain the referral code if needed) An Assessment of Assets for permanent entry into residential care by contacting either Centrelink or DVA (whichever is applicable)

Person requiring residential care: (Applicant)

Pension and benefit details:

Do you hold an Australian Pensioner Concession Card
If yes, indicate the type of pension:
Untitled
Are you an Australian Ex-Prisoner of War?