Submit a request – PRC Direct

Please choose your issue below

Your email address

Please choose your request type

Subject

Description

Please enter the details of your request. A member of our support staff will respond as soon as possible.

Referrer first name

Referrer surname

Provider number(s) or AHPRA ID

Please provide the Referrer Provider number(s) or AHPRA ID

Multiple clinic locations

Moved clinic locations

Surgery address or hospital address

Please provide the surgery or hospital (include all current locations); eg. Whitfords Family Practice or Hollywood Private Hospital.

Phone number:

Please include your contact phone number. It is important that support staff can get in touch with you as soon as possible. Please include numbers only, no spaces.

Attachments

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