End of Life Community Directory

Community Directory for people seeking services/support at the end their life

This 5-minute questionnaire will help us to identify and gather useful information to include in Council's proposed End of Life Community Directory. The information you provide will be made public on Council's website, so please only provide information for public access. If your organisation provides services, information or support to people at the end of their life or their carers, please take 5 minutes to complete this online form.

The Community Care Team

Eurobodalla Council

Please note: The information collected in this registration is transmitted and stored securely in the United States and is accessed by Council in accordance with SurveyMonkey privacy policy. By completing this registration you agree to this transfer. You may decline to provide this information by not responding to the registration. If you do provide an answer you consent to storage of your answer offshore (outside of Australia). This means that once you have chosen to participate in the registration, Council will not have an obligation to take reasonable steps to ensure that SurveyMonkey or SurveyGizmo does not breach the NSW Privacy Principles in relation to personal information given to SurveyMonkey.

Survey Monkey Privacy Notice

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* 1. What is the official name of your organisation? (Please add any abbreviations or commonly used names).

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* 2. Please list your office or service location including unit and street number, street name, town/city and postal code.

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* 3. Please list your official website address

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* 4. Please list the generic contact email address

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* 5. Please list the contact phone number for enquiries

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* 6. End of Life services generally fit into five categories. To help us to see where you fit, please tick the box or boxes that your organisation's support/service fits into below. We've listed some examples to help. THEN TYPE IN the exact service you provide in Answer 7. For example 'Disability Support'.

PHYSICAL SUPPORT including medical practitioners, specialist services, palliative care, geriatrician, pain and medical management, dietitian, podiatrists, naturopaths, masseurs, physiotherapists, health support, rehabilitation etc.

PRACTICAL SUPPORT including providing meals, mobility aids, special beds and other equipment, cleaning services, respite services, transport, home visiting hairdressers or veterinarians, gardening services, internet and technology support, home shopping etc.

WELLBEING SUPPORT including counsellors, psychotherapists, carer support, pastoral care, social workers, cultural groups/advisors, telephone support, volunteer visits, grief counselling, disability support, men's support groups, cancer support groups etc.

SOCIAL CONNECTION including groups such as Men's Shed, arts and crafts groups with a social support focus, cultural groups, grief support groups, suicide groups, parents and family support groups, carer groups, elders groups, exercise and walking groups, regular events for the aging etc.

INFORMATION SERVICES including legal services and Legal Aid, Public Trustee, Service NSW, Federal Government services, Advance Care Planning, NDIS, funeral services, financial planning, Home Care Packages, services that support people with dementia, Senior Rights Service and other advocacy services, superannuation advice etc.

Other (please specify)

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* 7. Please list your services (what you offer)

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* 8. Is there a fee for service?

Yes

Other (please specify, for example funding available, concessions etc.)

End of Life Community Directory

Community Directory for people seeking services/support at the end their life

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* 1. What is the official name of your organisation? (Please add any abbreviations or commonly used names).

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* 2. Please list your office or service location including unit and street number, street name, town/city and postal code.

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* 3. Please list your official website address

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* 4. Please list the generic contact email address

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* 5. Please list the contact phone number for enquiries

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* 7. Please list your services (what you offer)

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* 8. Is there a fee for service?

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* 9. Describe your service in 25 words or less

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* 10. Name of the person registering your organisation

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* 11. Telephone number or email address of the person registering your organisation