GP registrar availability to assist with COVID 19 vaccination clinic - Commonwealth funded

Registration

Thank you for completing this Expression of Interest (EOI) to voluntarily assist with additional COVID 19 vaccination work. This EOI is for potential work in:

Commonwealth funded COVID 19 vaccination clinics

Please note, additional commonwealth funded COVID 19 vaccination work does not generally count towards training. You are strongly encouraged to discuss this with your medical educator prior to accepting a COVID 19 vaccination clinic position.

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* 1. Please complete the details below:

First name:

Last name:

Email:

Best contact phone number:

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* 2. What is your current stage of training?

Hospital terms

Extended skills in hospital

First GP term

Second GP term

Third GP term

Fourth GP term

Extended skills in GP

Advanced Specialised Training/Advanced Rural Skills Training

Leave

Extension awaiting fellowship

Practice Experience Program (PEP) participant

Other (please specify)

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* 3. Do you have a preferred location to assist in the COVID 19 vaccination clinic?

No - I do not have a preference

Yes - My preferred location is:

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* 4. Please advise on your availability to assist with COVID 19 vaccination clinics:

How many days, which days and what hours are you available to work?

When would you be available to start (DD/MM/YYYY)