Patient-Centred Health Care Network

Expression of Interest


           Here is my contact information

Name
Title
Organisation
Work Phone
FAX
Email

          Here is the description which best fits my current situation

         

I would like to express my interest in 

Receiving further information about the Network as it develops. 
Hosting a speaker on this model of better health care at my organisation or group. 
Disseminating information on this model to my colleagues or community in 
          electronic format or   hard copy format 
Acting as a respondent giving my feedback on the design, development and implementation of the model.

Please contribute any further comments you wish to make:





         

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          PRIVACY STATEMENT:  Your details will be held in the strictest
           confidence and will not be passed onto a third party.

          Social Enterprise Partnerships Ltd
          ABN 47108742098
          2 Elm Street
          North Melbourne
          Phone (03) 9326 4481
          Fax (03) 9326 8030