Practitioner Registration

Doctor Details

Select Type *

Primary Category*

Secondary Category*

Title *

First Name *

Last Name *

Birth Date*

Email *

Phone *

Fax

Password * Required: At least 1 Uppercase, 1 lowercase, 1 digit, Allowed special characters @#*_-.!

Confirm Password * Required: At least 1 Uppercase, 1 lowercase, 1 digit, Allowed special characters @#*_-.!

Provide Rural health Service?

Practice Details

Name *

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Address Line 1 *

Address Line 2

State *

Suburb*

zipcode *

Address *

Having trouble entering an address? Enter manually

TimeZone *

Prescribing / Referral Details

Practitioner Number *

Prescriber Number *

AHPRA Registration Number *

Invoicing Details

The following details will be used to generate your monthly tax statement.

ABN *

Invoice Name

Invoice Address

Payment Details

The following details will be used so we can pay your monthly statement.

Account Name *

Account Number *

BSB *

Join a Pharmacy

A pharmacy in your area may have given you a code. This will list yourself as a preferred doctor at that pharmacy. When ordering repeat precription medication a customer of a local pharmacy may request that you specifically write their script.

Pharmacy Code

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