Residential Aged Care Waiting List Application

Thank you for your interest in Woolgoolga District Retirement Village. This form is to be completed for inclusion on our Independent Living Unit Waiting List. The information provided on this form will be maintained in a highly confidential manner, with only authorised staff provided access.

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CARE RECIPIENT DETAILS (The details of the person requiring residential care)
Type of Care required
Preferred Method of Contact
OTHER INFORMATION (Relating to the person requiring residential care)

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