NWMPHN is distributing PPE according to the tranche 4 guidelines from the Department of Health. 
As part of those guidelines the Department is prioritizing a supply of PPE to practices who are unable to source supply commercially.
Volume of PPE delivered will vary depending on levels of community transmission and stock.

If your practice believes it is in a high risk area and is assessing a large number of patients for COVID-19 symptoms, please fill out this survey.

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* 1. Business Name:

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* 2. Name of person making request:

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* 3. Street name e.g. Level 1 369 Royal Parade

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* 4. Suburb e.g. Parkville

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* 5. Postcode e.g. 3052

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* 6. Contact Phone Number

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* 7. Contact email address:

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* 8. Which specialty category does your business fall under?

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* 9. How many GP's/Pharmacists/Clinicians in your practice?

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* 10. Is your practice currently testing patients for COVID-19?

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* 11. What equipment are you requesting?

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* 12. Have you tried to source PPE commercially?

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* 13. Please provide a reason for your request

Thank you for completing this form. You will not receive an automatic receipt however if you're seeing this message we have received your request.
If we have questions regarding your request we will contact you, otherwise please ask your reception staff to keep an eye out for your delivery.

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