Expression of interest for the Domestic and Family Violence project

New registrations for the Domestic and Family Violence project have now closed.

Please feel free to express your interest for future training by completing this enquiry form.

Thank you.

Practice Name

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Maximum 255 characters

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Practice Address

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Practice Suburb

* required

Select option

Practice Phone

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Maximum 255 characters

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Practice Email

* required

Number of staff available to participate (approx.)

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We confirm we are eligible in accordance with the following criteria:

* required

are committed to a whole practice training approach

complete QI workbook with the support from the Primary Care Liaison Officer and Trainer

contribute to an evaluation of the project, with the competition of a pre-and-post survey

participate in the RACGP training (with a General Practitioner represented)

participate in training and support (with a whole-of-practice approach - practice manager, practice nurse and administration staff represented)

Please check box all options to participate. If you have any questions, please email amy.anderson@brisbanenorthphn.org.au or call 07 3490 3408.

Authorised representative name and role

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Please add the authorised representative name so that we can be in touch with you about your expression of interest.

Authorised representative contact details

Maximum 255 characters

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Please add the authorised representative contact details (if they differ from the above practice email and phone number).