AMA Victoria Hospital Health Check

Question Title

* Please fill in the demographic information below.

This information is not compulsory but by providing it you will be helping to ensure the integrity of the survey; that is, it will enable us to say with confidence that all survey respondents are doctors-in-training.

The demographic information you supply is not connected to your responses. It is not connected administratively and is separate to the survey.

All responses remain confidential and de-identified.

Title

First Name

Last Name

AHPRA number

Email Address

Question Title

* Declaration:

By ticking this box, I agree to participate in the survey.

Question Title

* AMAV Communications

I am not a member and I would like to be placed on AMA Victoria’s email list to receive updates from time to time including the results of the Hospital Health Check