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Medical Equipment and Aids 24/25

This is a preview of the Medical Equipment and Aids Application form. form. When you’re ready to apply, click Fill Out Now to begin.

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* indicates a required field.

Before commencing this application please ensure that your project has been assessed by the Executive General Manager, Clinical Governance. Evidence will be required at the completion of this application.

Applicant Details (Not Applicable)

You must be a permanent GCHHS staff member to apply for funding. Temporary GCHHS staff members must be in their role of employment during the period in which the project is funded.

Name *

First name	Last name

GCHHS ID No. *

Position *

Facility *

Unit *

Department *

Unit Location Equipment to be delivered *

Address line 1

Address line 2

Suburb	State	Postcode

Must be an Australian postcode.

Delivery Instructions *

Ie. Robina loading Dock

Phone *

Must be an Australian phone number.

Email *

Must be an email address.

Mobile Phone *

Must be an Australian phone number.

Medical Equipment and Aids 24/25

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*Please note*

Applicant Details (Not Applicable)

Please note