Request Form

Please Note:

The following masks are available through Western Victoria PHN (WVPHN) to general practices (including practices in Aboriginal community controlled health organisations), pharmacies and some allied health providers in our catchment region.

  • Surgical masks and P2 masks for general practices and community pharmacies with high risk populations
  • Surgical masks only for other community pharmacies and allied health professionals in high risk areas

Providers located in western Melbourne, should direct requests to North Western Melbourne PHN

For others outside the WVPHN area, find your local Primary Health Network via the Department of Health’s Primary Health Network map locator.

  • If you are requesting masks for a General Practice or Community Pharmacy, please fill out the form below.
  • If you are requesting masks for an Allied Health Provider, please refer to the Request Form for Allied Health

Request Form for General Practices and Community Pharmacies

  • Your details

  • General Practice or Pharmacy details

  • If you are requesting for a general practice, how many GPs work at your practice?
  • Provide street address only. No post office box numbers.

 

Last modified: 15 May, 2020