Clinic Groups Expression of Interest Home » Clinic Groups Expression of Interest Group Programs - Expression of Interest First Name * Surname * Date of Birth Email * Phone Number State of Residence * VictoriaNew South WalesQueenslandTasmaniaSouth AustraliaWestern AustraliaNorthern Territory Postcode Which group program/s would you like to register your interest for? * Circle of Security Bringing Up Great Kids Dialectical Behaviour Therapy (DBT) Other Would you like to receive information on other group programs run by Cairnmillar? Yes please No thank you Preferred group session time * Morning Afternoon Evening No preference Where did you first hear about Cairnmillar? Word of Mouth/Recommendation GP or Referring Doctor Social Media - Facebook, Twitter or LinkedIn Newsletter or Flyer Google or Other Search Engine Newspaper, Billboard, Signage, Radio or Community Notice Board Other Would you also like to receive information on our clinical services? Yes please No thank you Would you like to join our newsletter mailing list? Yes please No thank you Cairnmillar is committed to providing a quality service which includes ensuring that individual privacy is maintained. We are bound by the Privacy Act 1988 and the Health Records Act 2001 under which clients of the organisation are entitled to: Know why personal information is being collected and how it will be used; Ask for access to records, including your health information; Take up opportunities to stop receiving direct marketing material; Correct inaccurate information; Know which organisations will be given personal information; Ensure organisations only use information for purposes they have told you about; Find out what personal information an organisation keeps and how they manage it. Thank you for completing our expression of interest form. CAPTCHA Submit If you are human, leave this field blank.
