Dementia and Aged Care Services - Client Details Survey

Dear Valued DACS Clients and Carers,

In order to keep you up to date with the latest COVID information and DACS processes, we are asking for all clients or carers to complete a short survey providing up to date contact details including an email address.

Please complete our survey below.
The information you provide is secure and will not be used for other purposes or supplied to third parties.

We thank you for taking the time to complete and keep you informed with the latest DACS updates.

DACS Management

Question Title

* 1. What's your name?
(Please provide us your full name)

Question Title

* 2. What is your email address?
(If you do not have one please state N/A)

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* 3. What region are you located in?

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* 4. Please provide us the details of your next of kin.
(if they do not have an email address, please state N/A).

Name:

Relationship:

Email address:

Dementia and Aged Care Services - Client Details Survey

Question Title

* 1. What's your name?(Please provide us your full name)

Question Title

* 2. What is your email address?(If you do not have one please state N/A)

Question Title

* 3. What region are you located in?

Question Title

* 4. Please provide us the details of your next of kin.(if they do not have an email address, please state N/A).

* 1. What's your name?
(Please provide us your full name)

* 2. What is your email address?
(If you do not have one please state N/A)

* 4. Please provide us the details of your next of kin.
(if they do not have an email address, please state N/A).