Your First Name
*
and your Last Name
*
Your Email
*
example@example.com
Your Phone
*
Please include your country code ie. +61
Your Role
*
Please include your country code ie. +61
Your organisation/company name
*
Your company/organisations' website
*
Please select your business or organisation type
*
Please Select
Specialist clinic
Private hospital
Public hospital
GP clinic
Other - please comment below
Specialisation or department
*
e.g. Oncology, Cardiac, Occupational Therapy
State your organisation is based
*
Please Select
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
National
If one location, Suburb/City
Does your website provide information about accommodation?
*
No
Yes
Unsure
Is MediStays on your website?
*
No
Yes
Unsure
Do your staff currently use MediStays?
*
No
Yes
Unsure
How did you hear about MediStays?
*
A colleague
A patient/family member
Conference/Expo
Google search
Newsletter
Social media - LinkedIn
Social media - other (eg Facebook)
Other
Extra comments and questions
Newsletter
Yes, subscribe me to the MediStays newsletter.
Please verify that you are human
*
Newsletter Yes No - Hidden for Monday
Email Health Partners - used for Monday column
example@example.com
Submit
Should be Empty: