First Name *
Last Name *
Email *
Practice/Company Name
Practice Address
Practice Suburb *
Practice State
Practice Postcode
Are you already a Team Medical Customer Yes No
Do you know your customer number? If so please enter it below
What type of practice are you setting up? * Indigenous Health Centre Allied Health Chemist and Pharmacy Day Surgery Dental General Practice & Medical Centre Government or Education Occupational Health Hospital - Private and Public Nursing Homes, Aged Care & Community Health Other Podiatry Skin & Dermatology Specialist Centre
Will you be offering any additionalhealth service outside of those generally covreed by a GP? Please select all that apply from the below list. Immunisations Travel Medications Allied Health Services Antenatal Skin Cancer Checks Skin Cancer Surgery Cervical Screening Iron Infusions Cosmetic Injectables Point-of-Care Testing Health Assessments Spirometry
How many consultation rooms will you have?
How many treatment/procedure rooms will you have?
Will you have a separate waiting area for patients with a suspected respiratory illnesses e.g. INfluenza, COVID-19? YesNo
Will you have a separate room for the sterilisation of reusable instruments? YesNo
Do you have an budget estimate?
What date are you planning on opening your new clinic?
Please add any other notes that will help our team with your estimate here: e.g. preferred brands, type of set-up
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