Practice for sale form | South Western Sydney PHN

"*" indicates required fields

Ad manager

Contact for managing ad details*

First Name*

Last Name*

Email*

I understand this advertisement will not be placed unless this box has been ticked.*

Authorisation*

I am authorised to place this advertisement on behalf of my employer organisation for which this vacancy applies to.

I understand this advertisement will not be placed unless this box has been ticked.

Practice details

Details of practice for sale*

Trading name*

ABN*

Practice location*

Address*

Suburb*

Postcode*

Select Location*

Brief description to promote the sale of your practice*

Enquiries

Contact details for enquiries*

First name*

Last Name*

Email*

Phone*

Practice notice board dates

Notice start date*

Notice closing date*

Consent*

I acknowledge and consent to the collection and use of my personal information in accordance with South Western Sydney PHN’s Privacy Policy. I also acknowledge that I am not sharing another person’s personal information without their informed consent. I understand SWSPHN takes my privacy seriously and will handle my data securely.