My Anaesthetic

Want us to do all of the work for you?

Simply complete the below information and we will do the rest. There are no lock in contracts so you will always stay in control.

Name

First Name

Last Name

Qualifications

Speciality

AHPRA registration number

Phone

Email Address

Residential Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Postal address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Company name (as registered with your ABN)

ABN

Bank Name

Account Name

BSB

Account Number

Provider numbers and locations

Are the provider number(s) listed with health funds?

Your preferred health fund arrangement

Default RVG unit value (can be determined later)

$

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