Resident's relocation request (SDA Transitions)

Step 1 of 4

25%

Details and current home address

Resident's full name(Required)

First Last

House name(Required)

Resident's address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Future home address

New address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Furniture

Bed type being moved(Required)

Medical

Ensemble

Timber frame

Metal frame

Mattress being moved?(Required)

Yes

Side bed rails being moved?(Required)

Yes

Bed pump being moved?(Required)

Yes

PEG feed stand being moved?(Required)

Yes

Tall boy being moved?(Required)

Yes

Bedside drawers being moved?(Required)

Yes

How many bedside drawers are required to be moved?(Required)

Large art work being moved?(Required)

Yes

How many pieces of large art work are required to be moved?(Required)

Lamps being moved?(Required)

Yes

TV being moved?(Required)

Yes

Is the TV mounted on the wall?(Required)

Yes

TV Unit being moved?(Required)

Yes

Bookshelves or wall mounted features/shelving being moved?(Required)

Yes

Mobile hoist being moved?(Required)

Yes

Commode chair being moved?(Required)

Yes

Bed bath/trolley (belonging to resident) being moved?(Required)

Yes

Recliner being moved?(Required)

Yes

Additional wheelchair being moved? (Not including the wheelchair the resident is actively using)(Required)

Yes

Any other furniture being moved that is not listed above?(Required)

Yes

Please provide details on other furniture needing to be moved and the amount(Required)

Do you require removalist boxes?(Required)

Yes

PLEASE NOTE

ALL boxes must be returned after transitioning. They will need to be returned to Nulsen Disability Services. Please put in a maintenance request in the Portal for the boxes to be picked up.

PLEASE NOTE

Only items that are packed in specialist removalists boxes provided, will be collected, and transported. Personal items will not be transported unless these are packed in the specialised removalist boxes provided. Personal items that are packed in plastic bags will not be transported. Fragile and glass items must be individually wrapped and packed in the specialist removalist boxes provided for safe transportation. All boxes and furniture MUST be clearly labelled with the resident’s full name, description of contents, and correct address where the boxes are to be delivered. Nulsen Disability Services will not be responsible for loss or damage of any items.

Consent

I agree to the above note.

CAPTCHA

Resident’s relocation request (SDA Transitions)

Details and current home address

Future home address

Furniture

PLEASE NOTE

PLEASE NOTE