Please fill out the following application on behalf of your elderly loved one.

We will need a letter from a doctor or community health nurse indicating the homeowner's suitability of temperament and current health for homesharing. This allows us to assess whether or not our service can meet the homeowner's needs. We will also provide you with a authority of notice document to be signed by the home owner.

This form and the information in it is for the attention of Elder Home Share and will not be shared with third parties.

Please only list the next of kin contact details on one person acting as the representative for the home owner.