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Recruiting, retaining and supporting General Practitioners (GPs) in rural New South Wales, Australia.

RDN Locum Service

National Rural Locum Program

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Request for an RDN Locum

Please note that fields marked with an asterisk (*) are required in order to successfully register your application.

1. General Practitioner being replaced by RDN Locum

*Surname

*First Name

*Preferred Name

Other Names

*Principal Practice:
*Practice Name

Postal Address Line 1

Address Line 2

*Place Name

*State

*Country

*Postcode

*Telephone (Business Hours)

*Fax

*Email

*Practicing

Full time Part Time

*Reason for Locum need

Recreation/Leave

CPD

Illness

Other

*Number of GPs in Practice

2. Locum Requirements

*Period of Locum Required

From:
To:

*Are these dates negotiable?

Yes No
Comments:

*VMO Status Required?

Yes No
If yes, please specify location(s)

*List dates (days and nights) the Locum will be on-call (with practice and as VMO)

Surgery Required?

Yes No

Obstetrics Required?

Yes No

Accident & Emergency Required?

Yes No

Anaesthetics Required?

Yes No

Additional Specialities Required?

Please Specify

I the abovementioned, by clicking the 'Submit my Application' button, certify that the information contained herein is full and accurate.

Further information will be required once a locum doctor has been allocated to your practice.

A non-refundable deposit of 10% of the total cost of the locum is payable upon booking.

Thank You. Please submit this form or print and return to

RDN Locums Service
Northern Region Coordinator
Barwon Division of General Practice
Fax: 02 6742 3699
locumnorth@nswrdn.com.au

RDN Locum Service
Southern Region Coordinator
Murrumbidgee Division of General Practice
Fax: 02 6953 6653
locumsouth@nswrdn.com.au