GP Vacancy Registration

"*" indicates required fields

Name*

First Last

Email*

Contact Phone*

Practice / Medical Centre*

Street Address Address Line 2 City State Postcode

Role Title

Reason for Vacancy*

Minimum number of hours per week*

If other, specify hours*

Number of Vacancies*

Number of Current GPs at Practice*

Number of Consulting Rooms*

Number of Nursing Support Staff*

Clinical Software used*

Specify other software*

Billing Policy*

Online Bookings available?*

Yes

Onsite services available*

If other, specify onsite services*

GP supervisors available for GP Training programs?*

Yes

VISA sponsorship available?*

Yes

Patient Demographics

Local Hospital Facilities

Nearest Tertiary Hospital

Service Fee split

Local Schooling Options

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Name

This field is for validation purposes and should be left unchanged.