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PPE Order Form - Pharmacy Living with COVID Bundle

Please complete the form here and we will be in touch regarding your request.

PPE Order Form - Pharmacy Living with COVID PPE Bundle

  • Please identify who and where the PPE Bundles should be sent to:

  • Please fill out the table for each eligible phrrmacist. (click on the + button to add a new row, 1 row per pharmacist)

  • Pharmacist's NamePharmacist's AHPRANumberRequires P2/N95 S/R (90 units)Requires Face Shields (1 unit) 
  • Emergency Provision PPE - can only be accessed where there is no local supply available commercially, or from another State or Territory government scheme. (Leave blank if not required.)

  • Consent