G3CP Expression of Interest Question Title * 1. Surname Question Title * 2. Given Name(s) Question Title * 3. Email Question Title * 4. Telephone/Mobile Question Title * 5. Practice Name Question Title * 6. Practice Address Question Title * 7. Practice Telephone Question Title * 8. Visual Field Analyzer (please note the Humphrey Matrix is not suitable for the G3CP) Humphrey Field Analyzer Medmont Question Title * 9. Applanation Tonometer Goldmann Perkins Question Title * 10. Other services (eg. additional languages, OCT imaging) Question Title * 11. Please detail any private fees charged at your practice (incl. fees for imaging and visual fields) Question Title * 12. Required attachments - APHPRA Registration PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Required attachments - APHPRA Registration Question Title * 13. Required Attachments - Proof of professional indemnity insurance PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Required Attachments - Proof of professional indemnity insurance Done