Services Outreach Program - Medical Practices
Pride Australia
Practice Name
Practice Manager's Name
Contact Number
Email Address
Address
Address
Street Address Line 2
Suburb
State
Postcode
Type of Practice
GP Practice
Mental Health Service
Sexual Health Service
Pharmacy
Is your practice currently accepting new patients?
Yes
No
Is your practice LGBTQIA+ friendly?
Yes
No
Is your practice trans and gender diverse friendly?
Yes
No
Is your practice a pride safe space?
Yes
No
Does your Practice prescribe or fill any of the following medications?
Testosterone
Estrogen
Anti-Androgens
PrEP
Anti-Depressents
Anti-Anxiety Medications
Stimulants
Antipsychotics
Mood Stabilisers
Who are your Practice doctors, psychologists, psychiatrists and other clinicians, their specialties, what treatments they offer and (if possible) which of your staff are LGBTQIA+ friendly?
What is your current billing schedule?
Bulk Billing
Mixed Billing
Private, with medicare rebate
Private, no medicare rebate
Fees
Who is eligible for bulk billing / subsidy?
Not Bulk Billing
Health Care Card
Pensioners
DVA
Children
Students
All Patients
Do you wish to sign up for any of these programs?
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