Bupa Aged Care (Substandard Care) Class Action

Bupa Aged Care (Substandard Care) Class Action

Registration Form
Complete this form if you would like to register your interest in this class action against Bupa aged care in relation to understaffing and substandard care. You can also register your interest for our investigations against other aged care providers.

It does not cost any money to register and you will never be 'out of pocket' as a result of participating in this class action.

If you have any questions, please contact us by email at enquiries@echolaw.com.au.
Please provide your contact details below*

First NameLast Name
Email*

Confirmation EmailPlease confirm email by re-entering in second box
Contact Number*
Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry
Please confirm whether you agree to Echo Law's Privacy Policy*

I agree to Echo Law's Privacy Policy
Our Privacy Policy is available here.
Please verify that you are human*

Bupa Aged Care (Substandard Care) Class Action

Registration form
Which of the following best describes you?*

Registering for myselfRegistering for someone elseRegistering for someone who has passed away

Bupa Aged Care (Substandard Care) Class Action

Registration form - Registering for yourself
Who is your aged care provider?*
If Other, please specify
If you have been a resident with more than one aged care provider, please provide us details of a second provider at enquiries@echolaw.com.au
What is the name of your aged care home?
State
When did you enter the aged care home?

DayMonthYear
Note: if you are unsure of the exact date, please provide your best estimate.
Are you still residing in the aged care home?

YesNo
When did you cease to reside in the aged care home?

DayMonthYear
Note: if you are unsure of the exact date, please provide your best estimate.
Is there anything else you wish to tell us about your experience including relating to understaffing or substandard care within your aged care home?

Bupa Aged Care (Substandard Care) Class Action

Registration form - Registering for someone else
Details of care recipient you are registering on behalf of (if available)

First NameLast Name
Contact Number (if available)
Email address (if available)
Relationship to care recipient
Can Echo law contact the person directly?

YesNo
Are you the power of attorney of the person you are registering for?

YesNo
Who is the aged care provider of the care recipient?*
If Other, please specify
If the care recipient has been a resident with more than one aged care provider, please provide us details of a second provider at enquiries@echolaw.com.au
What is the name of the aged care home?
State
When did the care recipient enter the aged care home?

DayMonthYear
Note: if you are unsure of the exact date, please provide your best estimate.
Is the care recipient still residing in the aged care home?

YesNo
When did the care recipient cease to reside in the aged care home?

DayMonthYear
Note: if you are unsure of the exact date, please provide your best estimate.
Is there anything else you wish to tell us about your or the care recipients' experience including in relation to understaffing or substandard care within the aged care home listed above?

Bupa Aged Care (Substandard Care) Class Action

Registration form - Registering for someone who has passed away
Name of late care recipient you are registering on behalf of

First NameLast Name
Relationship to late care recipient
Are you an executor or administrator of the deceased's estate?

YesNo
Who was the aged care provider of the late care recipient?*
If Other, please specify
If the late care recipient was a resident with more than one aged care provider, please provide us details of a second provider at enquiries@echolaw.com.au
What is the name of the aged care home?
State
When did the late care recipient enter the aged care home?

DayMonthYear
Note: if you are unsure of the exact date, please provide your best estimate.
When did the late care recipient cease to reside in the aged care home?

DayMonthYear
Note: if you are unsure of the exact date, please provide your best estimate.
Is there anything else you wish to tell us about your or the late care recipients' experience including in relation to understaffing or substandard care within the aged care home listed above?

Upload your Resident Agreement and any other supporting documents:

Cancelof
Please provide copies of any documents relating to your aged care facility, such as any agreements on entering aged care, any Resident or Accomodation Agreements, any care plans, and/or complaints made to or about the facility.

We treat these documents with the strictest of confidence in compliance with applicable laws and regulations and will only use these documents for the purpose of the proposed class action.

If you don't have these documents readily available right now, you can send them to enquiries@echolaw.com.au as soon as possible. If you don't provide these documents, we may contact you at a later point to verify your registration and follow up on any outstanding materials.
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