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Expression of Interest

I am willing and able to use a code word system (“DHASWA Referral”) in my practice to identify and expedite doctor-patient referrals and appointments made via the DHASWA Doctors for Doctors list.
I hereby give consent for the details provided in the form above to be included in the Doctors’ Health Advisory Service Western Australia (DHASWA) Doctors for Doctors list, and used in accordance with the purposes of the list, including being made available to DHASWA staff, who may refer callers from the DHASWA call line to you, and being made publically available on the DHASWA website.