Request support

If you are a doctor or health professional and require support, please fill the registration form and we will be in touch with you. Please provide as many details as possible.

By agreeing to participate in this project you acknowledge the scope is limited to providing emotional and mentoring support. Neither ANU nor the participants in the program are providing or facilitating the provision of advice on patient care through this project. Patient care remains the responsibility of the treating medical professionals in the patient's country and ANU will not accept liability for claims relating to that care. Similarly, neither the ANU nor the participants in the program are providing treatment advice, including mental health advice, to meet the requesting practitioner’s personal needs, and ANU will not accept liability for claims relating to provision of such support.

Please add area code.
List the number of beds if applicable.
Please enter your National medical / health authority registration number.

Privacy policy

The information on this form is being collected by the College of Health & Medicine, Australian National University (ANU). The information is being collected, with your consent, in order to complete your registration for the ‘Global Mentorship & Support program for COVID Health Professionals’ initiative. The information will be used by authorised staff for the purpose for which it was collected, and any other purpose which you have expressly consented to. If you do not provide all the information that is requested on this form, it may not be possible for us to ensure appropriate arrangements for your participation in this initiative.

The ANU is committed to protecting personal information provided by you in accordance with the Privacy Act 1988 (Cth) and the information will be protected against unauthorised access and use.

All information collected by the University is governed by the ANU Privacy Policy.

For further information about how the University deals with personal information, please refer to the ANU Privacy Policy or contact the ANU Privacy Officer at privacy@anu.edu.au.

You may access or request correction of any personal information you have provided to ANU by contacting privacy@anu.edu.au.