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Call the Aged Care Advocacy Line, our national team of advocates is available Monday to Friday 8am–8pm and Saturday 10am-4pm

1800 700 600

Home Request a volunteer

Request a volunteer

Complete the form

Please confirm the older person is eligible for a Community Visitor by selecting one of the below

Currently live in an aged care home Approved and waitlisted for a home care package Currently receiving a home care package

Please indicate who has given consent for this referral

Older person Representative of older person

Name of person giving consent

What is their relationship to the recipient?

Referrer details

Self-referral Referring on behalf of an older person

Details of older person

Full Name

Country of Birth

Preferred language

Date of birth

Gender

Female Male Prefer not to say

About the older person

Please share information about the recipient that will assist us in making the right match (e.g. family and culture, work background, interests).

Does the older person have any health issues which may impact visits? Eg. mobility, hearing, eyesight, continence, dementia, challenging behaviour, etc.

Has the older person been vaccinated against COVID?

Yes No Prefer not to answer

Special needs groups* 
Note - we are required to ask this question by the Australian Government Department of Health*. Information is strictly confidential; it is reported to the department as anonymous data only. *As specified under the Aged Care Act 1997.

People from Aboriginal and Torres Strait Island Communities People from Culturally and Linguistically Diverse Backgrounds (CALD) People who live in rural or remote areas People who are financially or socially disadvantaged Veterans People who are homeless or at risk of becoming homeless Care-leavers (including Forgotten Australians, Former Child Migrants and Stolen Generations Parents separated from their children by forced adoption or removal Lesbian, gay, bisexual, transgender and intersex people None of the above

Visitor Preference

Gender Preference

Female Male Either

Age Preference

Any 18-25 26-35 36-45 46-55 55+

Language, cultural, religious preferences 
Does the visitor need to identify with the same special needs group as the recipient?

Yes No

Aged Care Provider Details

Aged Care Provider

First Name

Last Name

Address

Phone Number

Email Address

Acknowledgement of Traditional Owners

We acknowledge the Traditional Owners of the lands on which we work and recognise that it always has been, and always will be, Aboriginal land.
We honour the strength and resilience of Aboriginal and Torres Strait Islander peoples and pay our respects to all Elders past and present.

Diversity

Consistent with the vision of the aged care sector’s Aged Care Diversity Framework, our work aims for all older people to experience a high quality aged care system that ensures equitable access and outcomes and embraces their diverse characteristics and life experiences.

OPAN is funded by the Australian Government Department of Health and Aged Care.

1800 700 600

Aged Care Advocacy Line 8am – 8pm Mon – Fri | 10am – 4pm Sat

This number will connect you with the aged care advocacy organisation in your state or territory.

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Request a volunteer

Complete the form

Details of older person

About the older person

Visitor Preference

Aged Care Provider Details

Get support

Information

Education

About us

Acknowledgement of Traditional Owners

Diversity