Psychiatrist Registration Form

Contact Details

First Name

Last Name

Email address

Mobile number

Current Employment

Current position

Employer / Hospital

Specialty Training

What is your sub-specialty (if any)?

What year did you complete your training?

Locations of interest for establishing your private practice

Catering

To assist with catering on the night, please advise if you have any specific dietary requirements?

If Other, please advise

Future Communication

Are you happy to receive ongoing communication from Ramsay Health Care with regards to private practice opportunities?