New Client Intake

This intake form is for paid Clear Pathway clients and should be completed once your booking is confirmed. The form typically takes between 15–20 minutes to complete, ensuring we have the comprehensive information needed to support you effectively.

First name

Last name

Phone

Birthday

Day

Month

Year

Home address

Country/Region

Address

City

Zip / Postal code

Preferred name

Primary contact name

Relationship to client and authority to act

Current informal supports and formal services

Recent hospital admissions and relevant health conditions

Cognition, mood and social wellbeing

Living arrangements and the client’s main goals

My Aged Care status, assessments, approvals and current funding

Functional needs: personal care, continence, nutrition, mobility, transport, medications, domestic tasks and communication

Falls, home safety concerns or other immediate risks

Carer responsibilities, pressure and support needs

Cultural, language, communication and accessibility preferences

How soon is support required?

Upload relevant documents: Support Plan, Notice of Decision, GP summary or discharge information

I consent to Clear Pathway Aged Care Navigation collecting and using the information provided in this form, including health information and uploaded documents, to prepare for and deliver the agreed service. I confirm I have authority to provide information about another person.

Preparing for your Service

Georgia will personally review your information and use it to prepare for the agreed service. She may contact you if any details need clarification to ensure you receive the most relevant and supportive guidance.