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Partner Clinic Onboarding Form

Thank you for partnering with us to deliver exceptional medical services. This registration form is designed to collect essential information about your clinic to ensure a smooth onboarding process and ensure compliance is aligned with best practice standards.

"*" indicates required fields

Clinic Name*

ABN*

Clinic Address*

Opening Hours

Clinic Email*

Clinic Phone*

Clinic Website

Services offered*

Occupational Medical Assessments

Executive Health Checks

Audiometry

Spirometry

Physiotherapist

Fitness Assessment

Functional Assessment

Health Monitoring

Injury Management

Travel Vaccination

Family Vaccination

Pathology

Skin Screen

Stress Test

Yellow Fever

Parking available on-site?*

Yes

No

Does your clinic offer travel medicine?*

Yes

No

Please provide the level or years of travel medicine experience.

What travel network is the clinic affiliated with?

Is the clinic a Yellow Fever Accredited Clinic?*

Yes

No

Does your clinic provide a specific Travel Kit including post travel medications?*

Yes

No

Please list.

CREDENTIALS: Please upload Travel Medicine Resumes of clinicians delivering Travel Medicine services.

Drop files here or

Max. file size: 200 MB.

Clinic Point of Contact

1) Clinic Practice Manager*

Name

Email

Telephone

2) Medical Director/ Lead Medical Practitioner*

Name

Role

AHPRA Registration

Email

Telephone

In Clinic Equipment & Calibration

Spirometry

Descriptor: Compliance with Thoracic Society of Australia and New Zealand Spirometry Standards

Onsite Spirometry*

Yes

No (enter third party provider details below)

Clinic Name

Contact Email

Telephone

Last Calibration Date*

DD slash MM slash YYYY

Next Calibration Due date

DD slash MM slash YYYY

Upload Calibration Certificate*

Max. file size: 200 MB.

Audiometry

Descriptor: Compliance with Australian/New Zealand Standard – occupational noise management - audiometry assessment AS/NZS 1269.4

Type of Audiometry Available*

Audiometric Booth

Audiometry Non-Booth

Third Party Provider (enter details below)

Clinic Name

Contact Email

Telephone

Last Calibration Date*

DD slash MM slash YYYY

Next Calibration Due date

DD slash MM slash YYYY

Upload Calibration Certificate*

Max. file size: 200 MB.

Is your clinic currently accredited with an approved provider?*

Yes (who, please upload certificate)

No

Please upload your accreditation certificates.

Drop files here or

Max. file size: 200 MB.

Are you affiliated or a member of any professional body memberships?*

Yes (enter details below)

No

What sector has your clinic have been engaged to service?*

Private Enterprise

Government Agency

Enter the project your clinic has been requested to service

Cyber Security

Do you need a RHINO account creating?*

Yes

No

Please upload your privacy policy

Max. file size: 200 MB.

1. How do you ensure that patient data is securely stored and transmitted?*

2. Do you have access controls in place to limit who can view or edit patient data?*

Yes

No

3. How often do you update and patch your software and systems, especially those that handle sensitive patient information?*

4. Do you provide cybersecurity training for your staff, particularly concerning phishing and handling sensitive data?*

Yes

No

5. Do you have a process in place to detect and respond to security incidents, such as data breaches?*

Yes

No

6. How do you back up critical data, and what is your process for data recovery in case of a breach or ransomware attack*

7. Do you hold any cyber or information security certifications like ISO 27001:2022?*

Yes

No

Please upload your certificate of currency: Professional Indemnity Insurance, Workers Compensation.*

Drop files here or

Max. file size: 200 MB.

Please ensure all boxes are complete and correct then click submit

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