New Client Registrations

CLIENT REGISTRATION/ASSESSMENT FORM

If you are a frail older  person aged 65 years and over, or 50 years and over for Aboriginal and Torres Strait Islanders, please complete the form below AND also register through “My Aged Care” by telephoning 1800 200 422.  Please request “Community Transport – Ryde, Hunters Hill” as your preferred Service Provider.   “My Aged Care” has been established by the Australian Government to help you navigate the aged care system.  It has been designed to give people more choice, more control and easier access to a full range of aged care services.
If you are a person aged under 65, please contact the National Disability Insurance Scheme (NDIS) on 1800 800 110 to discuss your eligibility for an NDIS package, then please complete and submit the form below.  Thank you.
PART A
  • Mr/Mrs/Miss/Ms/Dr:
    Given Name:
    Family Name:
  • Date of Birth:
    Age:
    Male/Female
  • Usual Address:
    Postcode:
  • Telephone:
    Mobile:
    Email:
  • Current Address (if different):
    Postcode:
PART B
  • Emergency Contact:
    Telephone:
    Relationship:
  • Doctor's (GP) Name:
    Doctor's Telephone:
    Medicare No:
  • Are you Aboriginal or Torres Strait Islander?
    Country of Birth:
    Main Language:
  • Do you have cultural or linguistic needs?

    Do you live alone?
    YesNo

    Do you have a carer?( if YES please complete Part F)
PART C
  • Income:

  • Pension No.:
  • Living Arrangements:
    OwnedPrivate RentalPublic RentalOther

PART D – What is your ability to
  • Do Housework?
    Without HelpWith HelpCompletely Unable
  • Get places further than walking distance? (TRANSPORT)
    Without HelpWith HelpNeed specialised vehicle or ambulance
  • Go out for SHOPPING for groceries and clothes?
    Without HelpWith HelpCompletely Unable
  • Take your own MEDICATION?
    Without HelpWith HelpCompletely Unable
  • Handle own MONEY?
    Without HelpWith HelpCompletely Unable
  • To WALK? ie. walking stick, frame, wheelchair
    Without HelpWith HelpCompletely Unable
  • To BATHE/SHOWER?
    Without HelpWith HelpCompletely Unable
  • DRESS yourself?
    Without HelpWith HelpCompletely Unable
  • EAT?
    Without HelpWith HelpCompletely Unable
  • To the TOILET by yourself?
    Without HelpWith HelpCompletely Unable
  • To get out of BED and MOVE around?
    Without HelpWith HelpCompletely Unable
  • Do you need help to communicate?
    NoSometimesAlways
PART E
  • Do you have any health issues that will affect service delivery?

  • MOBILITY:
    Do you use:
    Can you get in/out of our bus?
    YesNoUnsure
  • ACCESS TO HOME
    Is it safe for our vehicle to stop outside your home?
    Car
    YesNo
    Bus
    YesNo
    Please state ALL access difficulties:
  • Do you need front seat of car?
    YesNo
    Do you need back seat of car?
    YesNo
  • Can you travel in a taxi?
    YesNo
    Do you have
    Guide DogOxygen CylinderOther
  • Do you receive other services from Home & Community Care?
    YesNo

  • How did you find out about Community Transport?
  • BODY WEIGHT
    Are you:
    Do you require bariatric aids?

  • I require transport for:

PART F (if applicable)
  • Carer's Given Name:
    Carer's Family Name:
  • Date of Birth:
    Male/Female
  • Carer's address:
  • State:
    P/Code:
    Phone:
  • Carer Country of Birth:
    Main Language:
  • Is Carer Aboriginal or Torres Strait Islander?
    YesNo
    Does Carer care for more than one?
    YesNo
  • Carer Residency Status:
    Co-resident CarerNon-resident Carer
  • Client/Carer Relationship:
    Friend or neighbourOther relativeParentSon or Daughter
  • Will Carer be travelling with you?
    YesNoSometimes
PART G
I understand that by using this service I consent to Ryde Hunters Hill Community Transport supplying non-identifying information to their funding bodies for planning and statistical purposes. I understand that Ryde Hunters Hill Community Transport will seek my consent before referring me to another service. I understand that I will be notified in writing of the success or otherwise of my assessment and that I will receive an information welcome letter and a copy of the Passenger Handbook outlining my rights and responsibilities. I understand that from time to time photos or videos may be taken during the course of our activities and used for promotional purposes. I understand I can call the manager if I have concerns about any of the above information.

I acknowledged the above.
*Please note from 1.7.15 all applicants over the age of 65 must also register via "My Aged Care" on 1800 200 422. Please request "Community Transport, Ryde Hunters Hill" as your preferred Service Provider, and advise us of your "My Aged Care ID number".

  • Date:
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Client Testimonials
  • “I would like to thank Norman for all his help today, making an extra trip back to return my lost property.  What a wonderful vounteer driver!”

    Veronica K
  • “Thank you for a great service.  Joseph drove me to and from Macquarie Centre.  Joseph was very helpful and assisted me to the door with care.  I appreciated this especially, as it was raining”.

    Mavis R
  • “I had a lovely trip today to Bondi Beach. Silvio also took us for a scenic drive on the way home and he is very knowledgeable about the area, thanks for a lovely day”.

    Betty W
  • “All your drivers are unsung heroes and they should be the ones receiving medals on Australia Day!  I would like to thank Iain who helped me yesterday as I was having a bad day and he made it better for me.”

    Olive S.
  • “Maria just wanted to say a big thank you for all our help last year and earlier this year and wanted to wish all the staff a merry Christmas as without our help she does not know how she would have coped without our assistance.”

    Maria C.
  • “I was very nervous today because it was my first time using your service but Steve the driver made my trip comfortable and I would like to thank Steve for all his help.”

    Mary S.
  • “Dianne, thank you for dropping the forms off at my home.    Such a load off my mind to know someone is there to help me to  my medical appointments. I really appreciate your dedication.”

    Edna E.
  • “Many thanks to all the drivers and bus assistants.  They are so helpful and make our social outings wonderful and enjoyable.  They are good drivers and we feel relaxed, safe and comfortable.”

    Betty W
  • “Thank you so much Robyn & Dianne for taking special care of us at Mary Poppins last week, your help was greatly appreciated.”

    Lauris & Ailsa (HHL)
  • “Malia & staff, thank you very much for caring and supporting my husband.”

    Sofi & Samir
  • “To all the voluntary workers & RHHCT tireless workers in the office for being so patient and understanding.  Thank you for all your tireless hands & feet.”

    Hazel S
  • “Stav & Malia, What a great trip I had thanks to the both of you.  You certainly went beyond your duties always there for us all and taking us to beautiful places, so relaxing, you both did work very hard and never grumbled.  I shall always remember Port Stephens trip so thank you both.”

    Joan R
  • “On behalf of the Eastwood Ladies Probus Club  we would like to pass on a very big thank you to Mike the driver who drove us to Ettalong Diggers Club for our Christmas in July Luncheon. Mike was a very careful, friendly and a thorough gentlemen which made our day very pleasant.”

    Barbara S.
  • “Dear Alan, Just a note to express our appreciation to you, as the driver, transporting the members of the Eastwood Garden Club today…. Thank you for being so pleasant and agreeable, with such competent driving skills.”

    Margaret C
  • “Thanks to Ken, who seamlessly handled the situation when bus had a flat tyre. Excellent composure and passengers were hardly inconvenienced at all.”

    Elaine C
  • “I had an enjoyable morning shopping at Macquarie (Centre) today…. Wonderful, friendly drivers and we are so well looked after. It’s a wonderful service.”

    Margaret W
  • “Thanks to all the Community Transport team for your tremendous, supportive, help. Heartfelt thanks for meeting the needs of people like me.”

    Daniel C