Anaesthetist Registration 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 (once off $99 for 15 completed online surveys + ANZCA CPD summary report - more info) The BasicsFirst Name*Last Name*Email*Not for publication - this is where your forms, invoices and list notifications will be sent Phone*Not for publication - we will use this if we need to contact youYour LocationCountry*Free & Trial Plans are ONLY available to Australian & New Zealand Anaesthetists. If you are not in Australia or New Zealand, please click here to try another plan.AustraliaNew ZealandCountryAustraliaNew ZealandChinaHong KongMalaysiaSingaporeOtherYour Main RegionPlease select your regionACTNSW - SydneyNSW - NewcastleNSW - AlburyNSW - CountryNT - Northern TerritoryQLD - BrisbaneQLD - CountrySA - AdelaideSA - CountryTAS - HobartTAS - CountryVIC - MelbourneVIC - CountryWA - PerthWA - CountryOtherRegion Details Your ProfilePost-nominals*Profile PhotoOptional. Files supported: jpg, gif, png, pdf Portrait Style (for example 200px wide by 300px tall) Alternatively you can send this to us later.Accepted file types: jpg, jpeg, gif, png, pdf.Personal @anaestheticgroup.com.au Email AddressOptional. Would you like a complimentary email address?e.g. [email protected]Would you like your @anaestheticgroup.com.au email address to appear on your profile page?This would allow patients to see this email address (e.g [email protected]) and easily email you directly. However, although we do have spam protection, it may result in people sending you unsolicited emails (if this happens please let us know and we can block the sender).YesNoWebsite Short LinkOptional. Would you like a shortlink?e.g. anaestheticgroup.com.au/surnamePremium ExtrasPremium Plan members receive their own custom domain name (e.g. dryourname.com.au) for free. It's all part of the Premium service. There are no ongoing costs whilst you remain a Premium Plan member of Anaesthetic Group. We will continue to renew and maintain your domain name and matching email addresses at no extra costs. However if you do decide to leave us, you can take your domain name with you. Your name is on the registration of the domain name.Complimentary Domain NamePlease list your first three choices e.g. dryourname.com.au or yourfullname.com or drlastname.com.auMatching Email AddressesYour domain name will be set up with a 'catchall' domain name - so anything you email @dryourname.com.au will go to you.If you would prefer specific emails to be forwarded to another email account please enter them here: e.g. [email protected] forward to [email protected] or e.g. [email protected] forward to [email protected] and [email protected] and [email protected]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. ANZCA 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. You can change this at any time and even advise your CPD Feedback Provider's contact details later. Which type of Feedback form would you like?Standard Post-Op FeedbackANZCA CPD Patient Experience SurveyCPD Feedback Provider's Contact NameOptional. You can change this at any time and even advise your CPD Feedback Provider's contact details later. CPD Feedback Provider's Email AddressOptional - You can change this at any time and even advise your CPD Feedback Provider's contact details later. 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, doc, docx, txt, rtf, html, jpg, gif, png.Extra Page 2Accepted file types: pdf, doc, docx, txt, rtf, html, jpg, gif, png.Extra Page 3Accepted file types: pdf, doc, docx, txt, rtf, html, jpg, gif, png.Extra Page 4Accepted file types: pdf, doc, docx, txt, rtf, html, jpg, gif, png.Extra Page 5Accepted file types: pdf, doc, docx, txt, rtf, html, jpg, gif, png.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 changes laterChanges to Pre-Op QuestionnaireChanges to Feedback FormAny other changes? 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. Customise your "About Me" section belowAlternatively, simply get in touch when you’re ready to update it, send us your changes, and we’ll bring your profile up to date for you Billing / Invoice DetailsThese 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 SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Other DetailsHow did you hear about us?Welcome Ascham friend!A special 30% discount will apply to you.We will apply this manually and refund you the difference for this first payment and all future payments will have the 30% discount automatically applied.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. Credit Card American ExpressMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.
