In-Home Aged Care Client Survey

About You

Please tell us about yourself

Your Home State *

Your Postcode *0 / 4

Are you over 65 and living independently in the community? *YesNo

Commente.g. any thoughts you have on this

Are you currently on an aged care package or expect to be eligible for one? *YesNo

Commente.g. any thoughts you have on this

Do you have a pet or pets in your household? *YesNo

Your Pets

Please tell us about your pet(s)

How many pets do you have?

Other species:If the species of any of your pets are not shown, please list them here

How long have you had your current pet?If you have more than one pet, just the one you've had the longest.

What are the benefits for you of having a pet companion?

Your Household

Please tell us about who you live with

Do you live alone? *YesNo

Commente.g. any thoughts you have on this

Is there anyone now that helps you to care for your pet? *YesNo

Commente.g. any thoughts you have on this

If you had to go to hospital who would care for your pet?e.g. children, neighbour, other family members, pet sitter

Your In-Home Aged Care Provider

Please tell us about your aged care provider

What services would you like an in-home aged care service provider to find for you If you had difficulty caring for your pet?WalkingFeedingTaking your pet to the vetGrooming (welfare related)Emergency foster careEmergency boardingCleaning of cages/fish tank/litter tray/removal of dog droppingsOther - please list:Vet fees and pet food would not be covered

Other servicee.g. any services not listed here you would like

Are you getting any of the above services from your current aged care package provider? *YesNo

Commente.g. any thoughts you have on this

Can you say who that provider is?

Your Vet

Please tell us about your vet and veterinary services

Do you go to a vet that provides discounted fees? *YesNo

Who is eligible for discounts?Aged pensionersDisability pensionersSeniors with seniors cardNDIS clientsUnemployed with health care cardOther - please list:(as far as you are aware)

Other persone.g. any person eligible for a discount not listed here

Your Responses

Can we contact you if we wish to discuss aspects of your responses? *YesNo

Name *

Email Address *

PhoneA phone number is appreciated but not required

Take our Survey

About You

Please tell us about yourself

Your Pets

Please tell us about your pet(s)

Your Household

Please tell us about who you live with

Your In-Home Aged Care Provider

Please tell us about your aged care provider

Your Vet

Please tell us about your vet and veterinary services

Your Responses