Application for Assistance - River Angels Margaret River

River Angels has been founded to assist those residing within the Augusta Margaret River Shire, whilst undergoing cancer treatment, by providing ancillary support services which are readily available to those living within Metro areas.

Ancillary support is intended as a short-term practical assistance, when treatment for cancer is impacting a person’s (or their families) capacity to remain independent at home. River Angels is solely funded through community donations and receives no government support. As such, the value of funds available at the time of an assistance request may fluctuate from time to time and will be factored in when considering the application.

The extent of ancillary support is limited both in value and to the services detailed in this section. Please note cleaning and gardening services are provided on a maintenance only basis, we are unable to provide full yard cleans or vacate level cleaning of houses.

A cancer diagnosis is not an automatic approval of a request for support, eligibility and availability of resources at the time of application will be assessed within the context of other support services and family resources available to individuals.

To be eligible for assistance, applicants must be undergoing active treatment or management of a confirmed and current cancer diagnosis, be residing within the Augusta Margaret River Shire, and be experiencing hardship as a result.

Are you completing this application on behalf of someone?(Required)

Name of person completing this application(Required)

First Last

Relationship to Patient(Required)

How/Where did you hear about River Angels?(Required)

Patient Details

Patient Name(Required)

Title First Last

Patient Date of Birth(Required)

Patient Gender(Required)

Does the patient identify as Aboriginal or Torres Strait Islander?(Required)

Patient Address(Required)

Street Address Address Line 2 State Post Code

Patient Phone(Required)

Patient Email(Required)

Emergency Contact

Emergency Contact Name(Required)

First Last

Emergency Contact Phone

Relation to Patient

Diagnosis

Name of cancer type(Required)

Diagnosis(Required)

(please be specific)

Where was the patient diagnosed?

Stage of disease(Required)

Treatment type(Required)

Treatment Centre(Required)

Date of diagnosis(Required)

Treatment Start Date(Required)

Would you like to add any further information?(Required)

Yes

No

Name of Doctor(Required)

Medical Practice(Required)

Other information

Please include information on what services River Angels can assist with

If unknown, please leave blank

This application will be assessed based on the level of information provided. Please note – this application for assistance is not an emergency service. Provision of the requested services may take up to 4 weeks from the date of verification. If approved: Our Support Co-ordinator will be in contact with you to discuss the services available. The applicant will be notified via email that the Application for assistance was unsuccessful.

Although due care has been taken to ensure the quality and legitimacy of service providers, River Angels and it’s authorised representatives accept no responsibility or warranties whatsoever (whether expressly or implied, contractual or statutory) for the quality, fitness, or suitability of any service provided by River Angles through its service providers or volunteers. Therefore, by accepting the provision of the requested services, you acknowledge and agree to utilise said services at your own risk.

River Angels must be notified if the applicant’s status changes during the support service delivery program.

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