To help us plan our distribution of masks issued by the Australian Government, we ask that eligible health care staff complete the below form so we can determine the mask requirements for your practice, pharmacy or health care service. To check that you are eligible, please refer to the Department of Health Distribution of PPE through PHNs guidance.

These masks are for patients who present with COVID-19 symptoms and/or staff who are performing a COVID-19 test. 

Please complete this form to confirm your mask requirements. 

Fields marked with an * are mandatory