WELCOME

We're excited to be working with you and your team to strengthen quality and safety at your service.

Please complete the details for all the facilities you would like Harcourt Aged Care Advisors to work with:

Organisation Name:

Organisation ABN:

Facility Name/s:

List all facilities you would like us to work with

RACS ID/s:

List all RACS IDs of all facilities you would like us to work with

Postal Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Key Contact Name:

First Name

Last Name

Key Contact Position:

Key Contact Email:

Key Contact Phone:

(###)

###

####

Finance Contact Name:

Who we speak to regarding invoice payment

First Name

Last Name

Finance Contact Email:

Finance Contact Phone:

(###)

###

####

Clinical Information System in Use:

Name of electronic information system in use, or paper based system

Other Contact Name:

First Name

Last Name

Other Contact Position:

Other Contact Email:

YOUR ONBOARDING SURVEY

The above questions assist us in planning for working with your team.

Please note all information collected in this survey is confidential and is only used by Harcourt Aged Care Advisors to assist in ensuring we can allocate the most appropriate staffing and resources to match your needs.