Doctor Enquiry

Thank you for showing interest in joining our esteemed team of healthcare professionals. We truly value your interest and commitment to our platform.

To better understand your background, expertise, and expectations, we kindly request that you complete a brief questionnaire. Your responses will assist us in assessing your suitability for collaboration with Hola Health.

Full Name *

Phone number *

Email address *

What type of practitioner are you? * Select... General Practitioner Fellow General Practitioner Registrar Specialist Fellow Specialist Registrar Nurse Practitioner Other

What state are you based in? * Select... WA NSW VIC QLD SA NT ACT TAS Other

Other State *

Please provide your AHPRA registration number. *

Are you currently under a 10-year moratorium? * Select... Yes No

Roughly, how many days per week are you able to consult? * Select... 1 Day 2 Days 3 Days 4 Days 5 Days 6 Days 7 Days

Roughly, how many hours per week are you able to consult? * Select... Below 10 hours 10 - 20 hours 20 - 30 hours 30+ hours

What days of the week can you consult? *

Monday Tuesday Wednesday Thursday Friday Saturday Sunday Varies

Please select the type of shifts you can offer. (NOTE: all options refer to within your own time zone) *

Early morning shifts Within standard business hours Evening/late night shifts Overnight shifts Weekends Varies

Do you have access to PRODA? * Select... Yes No Unsure

Are you limited to the amount of provider numbers you can have? * Select... Yes No Unsure

Anything else we should know?

Submit