"*" indicates required fields Step 1 of 4 25% NameThis field is for validation purposes and should be left unchanged.This free service is made available to GP practices and allied health professionals to foster interdisciplinary collaboration within South Western Sydney. If you are an allied health professional, complete this form to advertise your interest to practise in a shared space. About youYour profession*E.g. PodiatristYour professionPreferred locations (by Local Government Area)* Bankstown LGA Camden LGA Campbelltown LGA Fairfield LGA Liverpool LGA Wollondilly LGA Wingecarribee LGA Terms soughtOptional. Describe your preferences for contract length, payment terms, equipment and parking. See sample text for inspiration.Describe your preferred terms and days.Snippet*This short description appears on listing summary page. See sample text for inspiration.Example: [profession] with ## year's experience is seeking a room to practice in for five days a week within South Western Sydney. Open to negotiate. A brief description to appear on the listings summary page.Requirement and amenities sought*Describe parking, equipment, room size requirement here if not done so elsewhere. See sample text for inspiration.This is your main notice. Include as much information as possible. E.g. parking requirements, type of practice sought, room size and capacity.Available from: Estimated length of agreementE.g. three months, one year, or ongoing. Enter your preferred contact information for people to respond to your advert.First nameLast nameEmailPhone Advertiser details The below information will not be viewed on the website. Provide this information for South Western Sydney PHN to contact you in relation to any admin or technical aspects of your request.First name*Last name*Trading nameABNEmailPhoneAdvert start dateSTART DATE: Allow five days for your notice to reviewed and published Select a date in the future, allowing time for your request to be reviewed and published. If you leave this blank your notice will be published in approx. four business days.Advert closing date* Your advert will unpublish on midnight of the date you selectConsent* 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.