Request a Consumer Representative

Commitee name(*)

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Health Division(*)

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If other, please specify:

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As our Consumer Representatives Program is currently running close to capacity, HCCA has identified the following priority areas. Please select which of these areas are relevant to your committee. Please note: if your committee falls outside of these areas, HCCA will still process your request.(*)

Safety and Quality
Primary Health Care
Aged Care
Chronic Disease and Self-Management
Service InnovationInvalid Input

What role will the consumer representative have on the committee? (*)

To provide consumer perspective on the general business of the committee.
To provide consumer perspective on specific issues.
To review documents from a consumer perspective.
To make suggestions on how health services can operate with a consumer focus.
To identify consumer issues during the development of a project.
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If other, please specify: (*)

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Meeting Venue(*)

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Next Scheduled Committee Meeting(*)

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Meeting frequency (*)

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Meeting time(*)

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Number of Consumer Representatives Requested(*)

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Terms of Reference(*)

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Committee contact person(*)

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Position(*)

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Postal address(*)

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Phone number(*)

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Fax(*)

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Email address(*)

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Reimbursement Policy(*)

I am aware of ACT Health's Consumer, Carer and Community Representative Reimbursement Policy.Invalid Input

Please ensure all fields are completed before submitting your request. We cannot begin our processes to endorse an appropriate consumer representative without all of this information.