Prescriber Public Directory Listing Form "*" indicates required fields Practitioner Name*This is the name shown on your profile. Practitioner / Practice Email*This email address will be used for internal communication and when sending notifications to you from the website. Profession*-- Select One --GPMedical DoctorNeurologistNurse PractitionerPaediatricianSpecialistOncologistPsychiatristRheumatologistPrimary Clinic / Practice Name*Primary Clinic / Practice Suburb*Clinic State*-- Select one --ACTNSWNTQLDSATASVICWAProfile Image*This image will be visible to users.Accepted file types: jpg, jpeg, png, gif.Bio*This Bio will be visible to users, along with your areas of interest, spoken languages, qualifications and experience.Areas of Interest*Qualifications and ExperienceLanguages Spoken*Online Booking SystemIf your booking system can be opened in an iframe, please paste the URL here.Are you interested in participating in:*Please tick all that apply. Green Choices LGP Connect Quest Select AllAppointment Types Offered:*Please tick all that apply. Face to Face Telehealth Select AllMedication Types Offered:*Please tick all that apply. Flower Oil Select AllFeesAll fees to be in $AUD before Medicare rebate. These fees will be shown by default.Initial ConsultFollow Up ConsultConcession ConsultConcession Follow Up ConsultDisability Support Pension (DPS) ConsultDSP Follow Up ConsultPrescription ConsultOther FeesFee NotesAdd notes regarding the fees. These will be shown to the user.The QUEST InitiativeEnter fee amounts here for The QUEST Initiative if they're different to the above fees.QUEST Initial ConsultQUEST Follow Up ConsultQUEST Concession ConsultQUEST Concession Follow Up ConsultQUEST DSP ConsultQUEST DSP Follow Up ConsultQUEST Prescription ConsultQUEST Other FeesQUEST Fee NotesQUEST Online Booking SystemPlease enter a URL here if you have an iframe link that automatically specifies QUEST as the referrer.LGP ConnectEnter fee amounts here for LGP Connect if they're different to the above fees.LGP Initial ConsultLGP Follow Up ConsultLGP Concession ConsultLGP Concession Follow Up ConsultLGP DSP ConsultLGP DSP Follow Up ConsultLGP Prescription ConsultLGP Other FeesLGP Fee NotesLGP Online Booking SystemPlease enter a URL here if you have an iframe link that automatically specifies LGP Connect as the referrer.Green ChoicesEnter fee amounts here for Green Choices if they're different to the above fees.Green Choices Initial ConsultGreen Choices Follow Up ConsultGreen Choices Concession ConsultGreen Choices Concession Follow Up ConsultGreen Choices DSP ConsultGreen Choices DSP Follow Up ConsultGreen Choices Prescription ConsultGreen Choices Other FeesGreen Choices Fee NotesGreen Choices Online Booking SystemPlease enter a URL here if you have an iframe link that automatically specifies Green Choices as the referrer. "*" indicates required fields Practitioner Name*This is the name shown on your profile. Practitioner / Practice Email*This email address will be used for internal communication and when sending notifications to you from the website. Profession*-- Select One --GPMedical DoctorNeurologistNurse PractitionerPaediatricianSpecialistOncologistPsychiatristRheumatologistPrimary Clinic / Practice Name*Primary Clinic / Practice Suburb*Clinic State*-- Select one --ACTNSWNTQLDSATASVICWAProfile Image*This image will be visible to users.Accepted file types: jpg, jpeg, png, gif.Bio*This Bio will be visible to users, along with your areas of interest, spoken languages, qualifications and experience.Areas of Interest*Qualifications and ExperienceLanguages Spoken*Online Booking SystemIf your booking system can be opened in an iframe, please paste the URL here.Are you interested in participating in:*Please tick all that apply. Green Choices LGP Connect Quest Select AllAppointment Types Offered:*Please tick all that apply. Face to Face Telehealth Select AllMedication Types Offered:*Please tick all that apply. Flower Oil Select AllFeesAll fees to be in $AUD before Medicare rebate. These fees will be shown by default.Initial ConsultFollow Up ConsultConcession ConsultConcession Follow Up ConsultDisability Support Pension (DPS) ConsultDSP Follow Up ConsultPrescription ConsultOther FeesFee NotesAdd notes regarding the fees. These will be shown to the user.The QUEST InitiativeEnter fee amounts here for The QUEST Initiative if they're different to the above fees.QUEST Initial ConsultQUEST Follow Up ConsultQUEST Concession ConsultQUEST Concession Follow Up ConsultQUEST DSP ConsultQUEST DSP Follow Up ConsultQUEST Prescription ConsultQUEST Other FeesQUEST Fee NotesQUEST Online Booking SystemPlease enter a URL here if you have an iframe link that automatically specifies QUEST as the referrer.LGP ConnectEnter fee amounts here for LGP Connect if they're different to the above fees.LGP Initial ConsultLGP Follow Up ConsultLGP Concession ConsultLGP Concession Follow Up ConsultLGP DSP ConsultLGP DSP Follow Up ConsultLGP Prescription ConsultLGP Other FeesLGP Fee NotesLGP Online Booking SystemPlease enter a URL here if you have an iframe link that automatically specifies LGP Connect as the referrer.Green ChoicesEnter fee amounts here for Green Choices if they're different to the above fees.Green Choices Initial ConsultGreen Choices Follow Up ConsultGreen Choices Concession ConsultGreen Choices Concession Follow Up ConsultGreen Choices DSP ConsultGreen Choices DSP Follow Up ConsultGreen Choices Prescription ConsultGreen Choices Other FeesGreen Choices Fee NotesGreen Choices Online Booking SystemPlease enter a URL here if you have an iframe link that automatically specifies Green Choices as the referrer.