Addition to the Health and Service Providers (HSP) list

PART A

1. I want to add to this category:

CATEGORY: ---AccommodationChemist or PharmacyCounselingEndocrinologist General Practitioner (GP)GynaecologistLegal ServiceMen's HealthNeedle ExchangePsychiatristSexual HealthSurgeonYouth ServiceOther

IF you chose 'Other' above - please tell us the category:

2. It should be added to this area:

STATE/TERRITORY: ---ACTNew South WalesNorthern TerritoryNationalQueenslandSouth AustraliaTasmaniaVictoria Western Australia

PART B

1. These are the details for the service or health provider I want to add:

SERVICE PROVIDER DETAILS:

The name of the service provider:


Address:


Telephone:


Description of this service:

PART C

1. Any other comments or remarks?

I recommend this service provider based on my own personal experience
yes no 

I am this service provider and am putting myself forward for the HSP list
yes no 

If we need need more information about your entry or if any of the detail is incomplete, how can we contact you?

Name

Email Address