Aged Care Navigators – Form to send survey to Customer

Aged Care Navigators – Form to send survey to Customer

***FOR NAVIGATOR USE ONLY***

Use this form to send an email to your customers requesting surveys to be completed.

If you are looking to fill in survey responses from a PRINTED SURVEY  go here: https://www.cota.org.au/acnavs-printed-survey-entry/


  • Please enter the first name of the customer
  • Please enter the email that you would like to be sent the customers' portion of this survey
  • The response you enter here will be the email's 'sent from' name' and will be included in the email to the customer
  • Please select the trial that this customer accessed
  • Please select one only
  • Date Format: DD slash MM slash YYYY