Metro South Health - Become a consumer partner

I'm filling in this form because: *

I'd like to know more about becoming a consumer partner.I've spoken to a staff member and they've asked me to fill in the form.

Full name *

Email *

Phone *

Address line 1 *

Address line 2

Town or city *

Postcode *

Information about you

We ask for the following information to help make sure we have a range of consumer partners with different backgrounds and experiences. It also helps us match you with specific activities.

Gender *

FemaleMaleNon-binary or gender fluidPrefer not to say

How do you identify?

Are you of Aboriginal or Torres Strait Islander origin? *

Is English your first language? *

YesNo

Do you have a disability? *

YesNo

What areas of health care are you interested in?