Marketing Form

First Name

Last Name

Phone

Suburb Postcode

Are you enquiring on behalf of someone else?

Yes

If answer to above question is "Yes", Who will be the person receiving services?

How would you summarize your home care status?

I’m doing initial research into my home care options

I have had an Assessment via My Aged Care

I have been approved for the Commonwealth Home Support Programme (CHSP)

I have been approved for the Support at Home program

I already have Support at Home funding with another provider

Message

I would like to receive information about products and services offered by BaptistCare. By providing my personal information. I consent to be contacted periodically via email, telephone or other means unless I choose to opt out at any time

Yes

By submitting this form, I acknowledge that I have read and agree to the terms of BaptistCare's Privacy Policy. All personal information collected will be stored and managed in accordance with this policy.