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There is also a paper form for this booking, you can download it
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and send it to our email:
info@macben.co
and we will get back to you shortly.
Booking Request
Name
Phone
Email
Tell us about yourself:
*
Required
Do you have a family member going in to care?
Are you going in to care? Or thinking about going in to care?
Do you have a family member currently in Residential Aged Care?
Add answer here
How can we help you?
*
Required
Do you have a family member going in to care?
Are you going in to care? Or thinking about going in to care?
Do you have a family member currently in Residential Aged Care?
Add answer here
Name of person giving consent
Relationship to resident
Are you the EPOG?
Name of the Resident
Name of Facility
Facility contact number
Facility email
GP Practice contact details
GP Practice contact details
Pharmacy contact details
I give permission for MacBen Pty Ltd – Residential Aged Care Support Services, to obtain and share information between the RACF, GP Practice, Pharmacy and other related services that relate to the care of the above mentioned RACF Resident.
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