Treatment Directory Submission

As a support line for those living with hepatitis, Hepatitis QLD is regularly asked for contact details for GPs, clinicians, and pharmacies able to prescribe the new hepatitis C medications. Please join our directory and help people affected by hepatitis access the treatment they need.

Please use this form to add your details to our treatment directory or to update any existing details.

Question Title

* 1. Please choose a category

General Practitioner

Pharmacy

Liver clinic

Specialist

Other (please specify)

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* 2. Do you bulk bill?

Yes

Other (please specify)

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* 3. Please enter the contact details you wish to appear in the directory

Individual Name

Company Name

Address

Address 2

City/Town

State

Post Code

Email Address

Phone Number

Treatment Directory Submission

Question Title

* 1. Please choose a category

Question Title

* 2. Do you bulk bill?

Question Title

* 3. Please enter the contact details you wish to appear in the directory

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* 4. Website address to be listed on the directory

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* 5. Are there any other details you would like to add: