Telehealth Application Form
~2 minutes to complete
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (+61) 000 000 000.
Email
*
example@example.com
Are you currently registered by AHPRA?
*
No
Yes
What is your specialisation?
*
GP
Endocrinologist
Urology
Sports Medicine
Other
If specialisation not listed above - please specify
How many years have you been practicing medicine in Australia*?
Less than 1 year
1-3 years
3-5 years
5+ years
Are you familiar with TGA regulations for telehealth and TRT?
No
Yes
Do you have malpractice insurance covering telehealth?
No
Yes
Are you willing to prescribe TRT via telehealth, following appropriate blood tests and clinical assessment?
No
Yes
Availability
Weekdays (morning)
Weekdays (afternoon)
Week nights
Flexible / Ad hoc
How many consults per week would you ideally like to take on?
1-5
5-10
10-20
20+
What is your expected fee per consult (AUD)?
Consent
*
I confirm I am AHPRA-registered and agree to be contacted about this opportunity.
I consent to my information being used solely for recruitment purposes in accordance with applicable privacy laws.
Submit
Should be Empty: