Gallop, Giggle and Giddy Up: Young Veterans Race Day

Which program are you interested in?*

This is a dynamic form that will tailor options for you depending on your selections.

DVA - Household Services (HHS)

DVA - Veterans' Home Care (VHC)

NDIS

CHSP

Other

Provide a brief description of the program or service you would like if you don't see it above.

Are these services for you or for someone else?*

I am the Client

I am a Case Manager or Allied Health Provider supporting a Client

I am enquiring on behalf of a family member or friend

Name*

First

How would you like to be contacted?*

Generally, we will email you first, however please provide a phone number so that we can contact you if your spam filter prevents our email getting through.

Phone

Email*

Phone*

Feel free to provide a description of your service requirements.

We will be in touch to confirm your needs.

Would you like to provide your DVA information online so we can book your services immediately?*

If you have a Determination Letter from DVA, select "Yes" and you can speed up the process by providing these details to us now.

Yes, I'm ready to book my services

No thank you

Feel free to leave us a short message, or simply submit your details and we'll be in touch to discuss your requirements.

Have you already been approved for Household Services?

Yes - I have received a Determination Letter from DVA

Still In Progress

The DVA Client's name*

First

Your email address

Your phone number

Please select your approved Household Services

Select each service you have been approved for.

Domestic Cleaning

Lawn Mowing

Gutter Cleaning

Window Cleaning

Pool Cleaning

Solar panel cleaning

Meal preparation

Other

List any other Household Services not seen above here.

Please tell us a little bit more about your specific requirements:

Note: We require all 3 numbers to charge DVA directly for your services. These numbers can be found on your DVA Determination Letter or other DVA correspondence.

DVA Client Number

This is your normal DVA client number for all your dealings with DVA. IMPORTANT: We must have this number prior to booking your services.

Client TRN

IMPORTANT: This number is found on your Supplier Information Sheet, we are unable to commence services until this number is provided. An example of the location is shown below.

Client Reference Number

IMPORTANT: This number is also found on your Supplier Information Sheet, we are unable to commence services until this number is provided.

Feel free to upload a copy of your DVA Determination Letter.

This greatly speeds up the process and gives us the authority to commence placing your services.

Max. file size: 5 MB.

Address

Street Address Address Line 2 City State Postcode

Consent

I understand that my details are protected by the HFA Privacy Policy and that I won't be spammed or contacted for any other reason.

NOTE: If you have an @hotmail, @outlook, @live, or another Microsoft email account please check your spam folder for our reply.

Let us take care of it

Gallop, Giggle and Giddy Up: Young Veterans Race Day

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