BrainLink Support for Carers Program Registration Form
BrainLink Services Support for Carers Program is funded by the Victorian Government through the Victorian Support for Cares Program.  BrainLink offers a range of activities and events designed to support carers and give them a break from their caring role.  Caring for someone with a disability can be tough, so by supporting carers BrainLink aims to make a difference by giving carers a break, connecting them with other carers and supporting them to continue in their caring role.  BrainLink offers a wide range of activities both in person and  online via zoom.  

For purposes of this form a carer is any person who is providing unpaid support to the care recipient (person with a brain injury receiving care).  The carer does not need to live with the care recipient to be defined as a carer. Carer's may be a spouse, child of the care recipient, parent, friend or neighbour of the care recipient.

Care Recipients may have an:
  • Acquired Brain Injury 
  • Alcohol related brain injury
  • Brain cancer
  • Brain infection
  • Brain tumours
  • Concussions
  • Epilepsy
  • Head injuries
  • Huntington’s disease
  • Hypoxia/anoxia
  • Motor Neurone disease 
  • Multiple Sclerosis (MS)
  • Muscular Dystrophy
  • Parkinson’s Disease
  • Progressive neurological diseases
  • Stroke
  • Traumatic Brain Injury
Registration is free and can be completed:
  • Online by completing this registration form, or
  • Download our registration form and complete and email to carers@brainlink.org.au, or
  • Call a member of our friendly team who can assist to register you over the phone.   Phone: 0498 333 088
For more information on BrainLink and the services we offer, you can also visit our website  www.brainlink.org.au 

To register for our Support for Carers Program, please complete our registration form.  

For assistance with registering please phone the team on 0498 333 088.

Please note the information collected below is for statistical purposes, which BrainLink is required to report to our funding body The Department of Families, Fairness and Housing (DFFH).  Any information collected by BrainLink is confidential and is coded and not identifiable in our reporting. 

Consent to use the unidentifiable Carer and Care Recipients data in our reports is required to register.  For further details please read our Privacy Policy.

Our Complaints Policy
BrainLink is committed to providing a high quality service to all our clients.  If something goes wrong we need you to tell us about it, this will help us to improve our standards.  Information about our complaints process is available here.
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Carer Details
Email  (Carer) *
Title  (Carer)  *
First name  (Carer)  *
Preferred Name  (Carer) 
Do you have a preferred name to be called by that is different to your first name?
Surname  (Carer)  *
Gender Identity  (Carer)  *
Please specify the gender you identify with.
Pronouns  (Carer)  *
Please specify your preferred pronouns.
Date of Birth  (Carer)  *
MM
/
DD
/
YYYY
Country of Birth (Carer) *
Preferred Language  (Carer)  *
Do you require an interpreter?
Clear selection
If yes, please specify language 
Indigenous Origin (Carer)  *
Address  (Carer)  *
Please provide your unit/flat number (if applicable) street number, street name and street type
 Suburb  (Carer)  *
Post Code  (Carer)  *
Contact Phone Number  (Carer)  *
Residency  (Carer)  *
Do you live with the Care Recipient?
Relationship to Care Recipient *
eg Wife, Husband, Mother, Son 
Describe your carers role *
Are you currently receiving Carer Support from any of these providers? *
  • VMCH - Villa Maria Catholic Homes
  • Different Journeys
  • Caladenia Dementia Care
  • Catholic Care Victoria
  • Eastern Palliative Care
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