Assessing patient perceptions of telehealthThis form needs to be completed by each participating practice. While all individual practice information will be held in the strictest confidence, being able to group like practices will enable the development of peer groupings for benchmark development.This will provide researchers will the ability to assess comparative data based on demographic factors such as location, (rural vs metropolitan), practice size (number of GPs), percentage of telehealth patients, or mode of telehealth delivery. Provide your details below and we will contact you with additional information such as the study protocol.All questions marked with * are required.If you have any further questions, please feel free to contact our dedicated Telehealth study team, via: telehealthstudy@insync.com.au1. Fill in your registration detailsPractice/Facility Name* Your practice name as typed here will appear in your unique online survey and dedicated portal.Title Mr, Mrs, Ms, Dr, ProfContact First Name* Contact Last Name* Position/title Practice manager, owner, doctor...Contact Email Address* Enter Email Confirm Email Practice Phone Number* Postal address* Suburb* State*Please selectVICNSWWASAQLDNTTASACTPostcode* Location* Rural practice Remote practice Metropolitan practice Other Number of general practioners* Single practice 2 - 3 4 - 6 7 - 10 < 10 GPs Percentage of telehealth patients* Less than 10% 10 - 19% 20 - 29% 30 - 39% 40 - 49% Over 50% Drop down to select your local PHN*Please selectACT PHNAdelaide SA PHNBrisbane North QLD PHNBrisbane South QLD PHNCentral and Eastern Sydney NSW PHNCentral Queensland, Wide Bay, Sunshine Coast QLD PHNCountry SA PHNDarling Downs and West Moreton QLD PHNEastern Melbourne VIC PHNGippsland VIC PHNGold Coast QLD PHNHunter New England and Central Coast NSW PHNMurray VIC PHNMurrumbidgee NSW PHNNepean Blue Mountains NSW PHNNorth Coast NSW PHNNorth Western Melbourne VIC PHNNorthern Queensland QLD PHNNorthern Sydney NSW PHNNorthern Territory PHNSouth Eastern Melbourne VIC PHNSouth Eastern NSW PHNSouth Western Sydney NSW PHNTasmania PHNWAPHA - Country PHNWAPHA - Perth North PHNWAPHA - Perth South PHNWestern NSW PHNWestern Queensland QLD PHNWestern Sydney NSW PHNWestern Victoria VIC PHNYour local PHN has endorsed this study, therefore a 50% discount has been applied.Subtotal $ 0.00 Discount $ 0.00 GST $ 0.00 Total Due (inc GST): $ 0.00 Payment Method* Credit Card (VISA or Mastercard) EFT Bank details for EFT: Account Name: Insync Health Pty Ltd ABN: 93 628 383 684 BSB: 183 334 Account No: 304461320 Credit Card* MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Security Code Cardholder Name Join mailing list Please tick box if you do not wish to subscribe to our Insync Insights. CAPTCHA