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Request for palliative care practice visit

North Western Melbourne Primary Health Network (NWMPHN) and Eastern Melbourne Primary Health Network (EMPHN) have partnered with the North and West Metropolitan Region Palliative Care Consortium to offer general practices the opportunity to connect with local community based palliative care providers.

General practices can request a visit from a community palliative care team member to provide information, education, and support, and help improve understanding and access to community palliative care services.

This is open to any practice in the NWMPHN catchment, as well as practices in Banyule, Nillumbik and Whittlesea local government areas in the EMPHN catchment.
1.Practice name(Required.)
2.Name of person requesting the visit?(Required.)
3.Practice contact details(Required.)
4.Please select areas of interest you would like covered in your visit.(Required.)
5.Please rate your practice's current level of awareness and engagement with community palliative care.(Required.)
Low
Moderate
High
6.Community palliative care providers are determined by local government area (LGA). Please select the LGA your practice is located in.(Required.)