Aged Care Volunteer Visitors Scheme (ACVVS) – Care recipient referral form

Use this form to provide a person's details, including any preferences, to help match them to a suitable volunteer visitor. You can complete this as an aged care service provider, a volunteer visitor auspice coordinator, a person wanting to be visited or their representative.

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Aged Care Volunteer Visitors Scheme (ACVVS) – Care recipient referral form

You can also use the webform to Request an Aged Care Volunteer Visitors Scheme (ACVVS) visitor.

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Publication date:
Date last updated:
Publication type:
Form
Audience:
General public
Language:
English
Description:

This form is confidential when completed. It asks for details of:

  • the referrer
  • the person consenting to the referral
  • the care recipient
  • any preferences the care recipient has regarding their visitor, including their gender, age range or background

This is an optional form. Auspices are welcome to use their own form if they wish.

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If you would like a response please use the enquiries form instead.