Allied health services are able to request a box of surgical masks and one allocation of reusable goggles for the use of their staff  when there is no available commercial supply and they have significant contact with people presenting with fever or respiratory symptoms.

Deliveries to allied health will occur on Monday, Wednesday and Friday via courier. Deliveries can only be made within the North Western Melbourne PHN catchment. Check if you are in our region here.

To apply for masks please complete this survey below.

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* 1. Organisation name:

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

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* 3. Suburb e.g. Parkville

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* 4. Post code e.g. 3052

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* 5. Deliveries should be made to practice locations. If you have entered a residential address please tick that you are happy to have the delivery left in a safe place if you are not at home.

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* 6. Business email address:

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* 7. Business phone number:

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* 8. If your practice requires reusable goggles, it is recommended each staff member (including front of house) have 2 pairs as per the Tranche 4 guidelines. Please specify number of goggles your practice is requesting below

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* 9. Please select which allied health practitioners work at your clinic:

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* 10. How many practitioners are operating in your practice?

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* 11. Please provide a reason for your request

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* 12. Name of person making request:

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* 13. Role:

Thank you for completing this form.  We will contact you on the email address provided regarding the status of your request. If you have any questions, please email primarycare@nwmphn.org.au
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