Medisecure

NEWS:

MediSecure® major sponsor at pac10, the PSA annual conference.

Congratulations to Amy Doolan from Terry White Chemist Hamilton on winning the iPad

MediSecure® congratulates the RACGP and AAPM for a very successful GP10

Doctors,
Join MediSecure® to promote better health outcomes for your patients.

There are no fees for doctors to join or use MediSecure® - simply fill out the form below and we will get you connected.

Mandatory fields indicated by *

Personal Details

First Name

*

Last Name

*

Position

*

Practice Name

*

Company Name (if different to Practice Name)

ABN

Format: dd ddd ddd ddd

Clinical System

*

Clinical Messaging System(s)

Multiple Selection: Hold the "Ctrl" key as you select.
Mac Users: Hold the "Command" key as you select.

*

Medical Group Name

Phone number

*

E-Mail Address

*

Practice Website

Practice Address

*

Practice Suburb

*

Practice State

*

Practice Post Code

*

Postal Address as above

Postal Address

*

Postal Suburb

*

Postal State

*

Postal Post Code

*

Name and prescriber # of each doctor practising from this location

First Name	Last Name	Prescriber #

Additional Information

I wish to join MediSecure® and I have read and agreed to the terms and conditions. *
I have the authority to enter this Agreement on behalf of this practice. *