This online form will ask you for information about your interest in participating in the Aged Care Quality and Safety Commission’s Consumers and Families panel. It will also ask for some information about you.

We will use this information to contact you with general information and for specific consultation opportunities. Our Consumers and Families panel currently has over 300 members. We will do our best to invite you to share your views on topics most relevant to you.

This online form should take around 10-15 minutes to complete. Mandatory questions are marked with an asterisk *.

Privacy statement
Your personal information is protected by law, including the Privacy Act 1988 and the Australian Privacy Principles.

Any personal information you provide is being collected for the purposes described above. We will keep your survey responses in confidential and secure storage and only share aggregate survey statistics with anyone external to the Commission. Read the Notice of Collection on our website for more information.

Read the Privacy statement on our website for more information about the way the Commission will manage your personal information.

Q3 How do you describe your gender?
* Q4 Please mark the option below that best describes you. You must choose one of these options to be on our panel.
I am:
Q5 Are you joining the panel as an individual or representative of an organisation? Tick all that apply.
Q6 We are aiming to include people from diverse backgrounds on the panel. Please tell us more about yourself.
Please tick as many as apply to you.
Q9 Please select any aged care topics or issues that are of particular interest to you.
You can select as many as you like. This does not mean we will only ask you about these topics.
* Q10 Panel members are spread across Australia and we acknowledge the different communication preferences of each panel member. Please tick all the different ways we can communicate with you.

Q12 Please indicate the different ways you would like to share your feedback with the Commission.
Tick all that apply
Q13 Please provide details of any assistance or adjustments you need to ensure we communicate effectively with you.
Tick all that apply.
Q15 Please tick the box below to confirm that you agree to the following statements.
I agree:
• to respect the privacy of other panel members and not disclose personal information about any other people during panel engagements
• that, if the Aged Care Quality and Safety Commission asks me to keep certain sensitive information confidential, I will not share it outside of panel engagements
• to listen to the views of others on the panel even if I don’t agree with them and allow time for others to speak. I understand that all people will be supported to share their opinions and experiences
• to speak to other panel members and Commission staff politely and respectfully
• I understand that the Commission will listen to and consider all feedback but that my individual views and opinions may not be reflected in what the Commission decides to do.
Thank you for taking the time to express interest in the panel. We will keep your personal information in a secure database. We will send you more information within 14 days.

Please click 'Submit' to submit your responses.
If you have any questions about the panel or this online form, please call us on 1800 951 822 or email consumerengagement@agedcarequality.gov.au
Submit