Refer someone | Auslancare

Fields marked (required) must be filled in. Everything else is optional.

1. About the person needing support

First name (required)Last name (required)

Preferred namePronouns

Date of birthSuburb or town (required)We support people across Victoria.

Hearing

Languages they use Auslan English Other

2. About you, the referrer

Who are you? (required)

Your name (required)Organisation

Your relationship to the person

Your email (required)Your mobile

The person knows about this referral and agrees to it. (required) Auslancare can contact me about this referral.

3. Support they would like

Services (required, choose any) Supported independent living (SIL) Self care Daily living (household tasks) Aged care support at home (private) Auslan interpreting or translating Not sure yet

Preferred times Weekday daytime Weekday evening Overnight Weekends Public holidays

Hours per week, roughlyHoped-for start date

Support worker preferences

GenderDeaf worker

Auslan

Their goals

What would they like support to help with? One goal per box.

Goal 1Goal 2

Anything we should know to visit safely

4. Funding

How will support be paid for? (required)Email for invoices

5. How we reply

How should we reply? (required) SMS Video call in Auslan Email

Mobile for our reply (required)Anything else you would like to tell usAuslancare can keep these details to respond, as set out in the privacy policy. (required)