Carer Gateway Support Referral

If you are a carer, or someone you know is a carer of an individual who has;

  • A disability; or
  • A life limiting health/medical condition; or
  • A mental illness; or
  • Is frail and aged 

If your referral is urgent, please contact The Carer Gateway on 1800 422 737, otherwise please complete this referral form and our team will contact you within 10 business days.  

To understand how we collect, use and store your personal information, please see our Privacy Collection Notice.

You can also get more information about our processes in our Privacy Policy.

Carer Gateway Support Referral Form

Website Referral
About the carer

About the Carer

Gender* - required
Employment Status of the Carer Identified Above* - required
Please Confirm the Carer Status of the Carer Identified Above* - required
About the carer 1
Is an interpreter required?* - required
How Many Ppl

About the Care Recipient

Please add as many panels as you require (up to 5 panels only) to fill in details for your care recipient(s). You can add a new panel using the green “Add New” button at the bottom of the section. If you need to submit a form for more than 5 recipients, please submit an extra form with their details for the remaining recipients.
About the Care Recipient
Gender* - required
Does the Care Recipient Live at the Same Address as the Carer?* - required
If Applicable, Please Identify the Funded Plan/Package the Care Recipient(s) Are Accessing* - required
Home Assessment Completed?* - required
Preferred Contact Time
Consents
Please read and give your final consents below before submitting this form.
Consent to Share Your De-identified Information (i.e. no names shared)* - required
Carer has Consent to Act on Behalf of the Person They Care For? (i.e. organise and set up services etc.)* - required
Consent to Have Personal Information Stored in The Benevolent Society Database* - required
Consent to Participate in Follow-up Research, Surveys and Evaluation* - required
Mandatory field(s) marked with *
Please wait a couple of minutes after pressing Submit for the form details to be sent to the team. You will be redirected to a Thank You page to confirm that your details have been sent to our support team.