Clinical Council Expression of Interest Form

Clinical Council Expression of Interest

Country SA PHN is seeking passionate individuals residing or working in the country South Australia to join our Clinical Council.

"*" indicates required fields

Name*

Prefix First Last

Phone*

Email*

Occupation*

Town*

Please outline why you would like to join Country SA PHN's Clinical Council*

Please describe how you will provide a broad perspective on clinical issues from your respective community*

Please provide information about any previous clinical governance experience*

Where relevant, please demonstrate your alignment with Country SA PHN's values – Innovation; Accountability; Relationships; Respect*

Please provide any other information you would like to share.

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