Anaesthetist Registration Step 1 of 4 25% Your PlanSpecial Offer (hidden)Free 60 Day TrialFree 30 Day TrialPES LaunchDefaultFree 60 Day Standard Plan Trial applied.You will not be billed until after your 60 day complimentary subscription ends and then you can cancel at any time.Free 30 Day Standard Plan Trial applied.You will not be billed until after your 30 day complimentary subscription ends and then you can cancel at any time.Your Plan100% Free Plan - $0 per monthStandard - $59 per monthPremium - $125 per monthClick here to see the plans availableSpecial Patient Experience Survey Launch Offer applied.You will only be billed a once off $69 amount saving you 30%!Would you like any add-ons? Patient Experience Survey ($99 for 15 completed online surveys + ANZCA CPD summary report - more info) The BasicsFirst Name*Last Name*Email*Not for publication - this is where your forms, invoices and list notifications will be sent Phone*Not for publication - we will use this if we need to contact youYour ProfilePost-nominals*Country*AustraliaChinaHong KongMalaysiaNew ZealandSingaporeOtherCountry*Free & Trial Plans are ONLY available to Australian Anaesthetists. If you are not in Australia please click here to try another plan.AustraliaYour Main RegionPlease select your regionACTNSW - SydneyNSW - NewcastleNSW - AlburyNSW - CountryNT - Northern TerritoryQLD - BrisbaneQLD - CountrySA - AdelaideSA - CountryTAS - HobartTAS - CountryVIC - MelbourneVIC - CountryWA - PerthWA - CountryOtherRegion DetailsProfile Photo (optional)Files supported: jpg, gif, png, pdf Portrait Style (for example 200px wide by 300px tall)Accepted file types: jpg, jpeg, gif, png, pdf. Optional Included ExtrasPersonal Email AddressWebsite Short LinkComplimentary Domain Name:Matching Email Addresses:Feedback FormWe offer two types of Feedback forms: 1) Standard Post-Op Feedback – with responses direct to the anaesthetist (no CPD credits) 2) ANZCA CPD Patient Experience Survey – compliant surveys (receive CPD credits)Click here to read more. You can change this at any time and even advise your Administrator contact details later. Which type of Feedback form would you like?Standard Post-Op FeedbackANZCA CPD Patient Experience SurveyCPD Feedback Provider's Contact NameANZCA recommends you have a 'Feedback Provider' (e.g colleague) to meet to discuss the PES results. We will send them a copy of each survey and once 15 are received we will create and send them your completed PES Summary Report.CPD Feedback Provider's Email Address Premium Pages, Questionnaire & Form ChangesWould you like to add your 5 Extra Pages Now?Please ChooseYesNo - I will email them laterNot requiredPlease upload your files in PDF format. If you do not have files ready now and would like to send them to us later (or have us convert them to PDF) please email them to [email protected] Extra Page 1Accepted file types: pdf.Extra Page 2Accepted file types: pdf.Extra Page 3Accepted file types: pdf.Extra Page 4Accepted file types: pdf.Extra Page 5Accepted file types: pdf.Extra Page CommentsBy default we will name the links to your forms as their file name. If you would like any other names listed or have any special instructions please include them in this box. Would you like to customise your questionnaire or forms now?Please ChooseYesNo - I'll email with changes later if neededChanges to Pre-Op QuestionnaireChanges to Feedback FormBilling / Invoice Details:These details are for Anaesthetic Group use only. They are NOT shared publicly or given to patients.Company NameABNBilling Address Street or PO Box Address Suburb State Post Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe About Me sectionBy default the About Me section on your profile page is set as: Dr YourFullName is a consultant anaesthetist who will be working with your surgeon for your upcoming procedure. About Dr YourFullName As an Anaesthetist, Dr YourFullName is a medical specialist who helps you through your operation. Dr Surname is an Australian doctor who is officially recognised as a consultant in the speciality of anaesthesia. Dr Surname is also a Fellow of the Australian and New Zealand College of Anaesthetists. What do you need to do? Not all anaesthetics are the same. Therefore, to provide you with the safest and most effective anaesthetic, it is essential that Dr Surname has your full medical and surgical history. In order to assist with this, Dr Surname requests that all patients complete the Pre- Op Questionnaire. All feedback welcome After your procedure Dr Surname would appreciate you taking just a few minutes to fill out the Patient Experience Survey. Your answers are completely anonymous and will help Dr Surname greatly in improving care for patients in the future. If you would like to discuss any aspect of your anaesthetic or if you have any questions either prior to or after your operation, please do not hesitate to contact Dr YourFullName. Alternatively feel free to customise your "About Me" section below: Other DetailsHow did you hear about us?Any Other Feedback or Comments?We love Feedback! If you have any feedback on our website, plans or anything else, please let us know.Payment InformationPayment MethodCredit Card (Amex, MasterCard or Visa)PaypalSpecial 60 Day Trial Price: $ 0.00 Special 30 Day Trial Price: $ 0.00 Free 60 Day Standard TrialPlease note: As our Eway payment gateway can't do trials, if you pay by Credit Card you will be charged $0.01 today.You will only be billed for the $59 per month Standard Plan fee after your 60 day complimentary subscription ends. Price: $ 0.01 Free 30 Day Standard TrialPlease note: As our Eway payment gateway can't do trials, if you pay by Credit Card you will be charged $0.01 today.You will only be billed for the $59 per month Standard Plan fee after your 30 day complimentary subscription ends. Price: $ 0.01 Free 60 Day Standard TrialYou will not be billed until after your 60 day complimentary subscription ends and then you can cancel at any time. Price: $ 0.00 Free 30 Day Standard TrialYou will not be billed until after your 30 day complimentary subscription ends and then you can cancel at any time. Price: $ 0.00 Patient Experience Survey Add-On Price: $ 99.00 Patient Experience Survey Add-On **LAUNCH OFFER** Price: $ 69.00 Total $ 0.00 As you have selected the 100% Free Plan there is nothing to pay. Please click Submit below to have your account created. 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