Priority of access

In accordance with the Australian Government's Priority of Access Guidelines, please mark the following if applicable:

Medical Details

Preferences

When would you like your child to commence care?

Please rank the days of the week from 1-5 to indicate your preferred days for care. The more options you are able to provide for days of care, the higher the chance we will be able to satisfy your care requirements. Note:

• Highest preference days are indicated with 1st and lowest as 5th
• If any given day of care is not suitable, record it as N/A

Other Children

If there is more than one child, please enter their details here

Medical Details