Download and complete the Aged Care Application for the Dementia and Cognition Supplement in Home Care form.
This form must be completed and signed by an authorised person of the approved provider.
To submit this form, register a Dementia and Cognition Supplement event on the Aged Care Provider Portal (ACPP). You can then upload the form and any additional documents.
If the ACPP is not available, return the completed form and supporting documents by following the instructions on the form.
To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.
If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.