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Emergency Information

So we can help you quickly in an emergency.

This form helps us assist you in an emergency. The details are stored securely in Australia and are used only to provide information to emergency services and our village call centre if needed. It's completely voluntary โ€” and you're welcome to ask a family member or our office staff to help you complete it.

Already submitted before? If we've given you a PIN, enter it to load your details and make changes. New here? Just fill in the form below.

About you

Your doctor & health cover

Medical conditions

Tick any that apply to you.

Allergies

Leave blank if you have none.

Medications

List the medications you take regularly. Leave blank if none.

Who to contact

Please give at least one emergency contact.

Contact 1
Contact 2
Contact 3

Consent

Stored securely in Australia. Used only to help us assist you in an emergency.