fbpx
Blue sky background

Onboarding Form

Signup

To connect to Rosie, please complete the following online form.  Alternatively, if you would like to download a copy of the form please click the button below. A Vitalcare representative will be in contact with you to gather the rest of the information required.  If you do not know the answer to the question, please leave the field blank.

____________________________________________________________________________________________________

Your Details

Person completing this online form

____________________________________________________________________________________________________

Resident Details

Person who will be using the Rosie service

____________________________________________________________________________________________________

Access information

How do emergency services enter the resident’s home if locked?

____________________________________________________________________________________________________

Who is the customer

Who will pay for Rosie?

____________________________________________________________________________________________________

Contact 1 (REQUIRED)

Agrees to be contacted at the time of emergency, or wants to be informed afterwards and has acknowledged that calls between Contact and Rosie will be recorded.
e.g. daughter, friend, neighbour, carer

____________________________________________________________________________________________________

Additional Contacts (OPTIONAL)

Agrees to be contacted at the time of emergency, or wants to be informed afterwards and has acknowledged that calls between Contact and Rosie will be recorded.
Copyright 2019 | Vitalcare Pty Limited