GP Registration Information
   
 

To fill out the Diary over the internet, you must first be registered with a User Name and Password.

Please fill out the form below to register.

Please Note:

  • If you are already filling out a paper based diary, please use the details found in the front cover of your booklet.
  • If you are not presently filling out a diary and would like to, please indicate this by answering no to the question in the form - "Are you currently filling out a Service Monitor Diary?". You can still fill out the form and we will contact you to verify your details.
  _________________________________________________
 
  Title
 
  First Name*
 
  Last Name*
 
  Email Address*
 
  Address Line
 
  Suburb
 
  State
 
  Postcode
 
  Phone (BH)
 
  Choose one:
 
  GP  Specialist  Hospital Pharmacist  Community Pharmacist
   
  Are you currently filling out a Service Monitor diary?
  Yes   No
 

* Required Fields.