Expression of Interest Application: Improving Oral Healthcare for People with Intellectual Disability Program

This Expression of Interest (EOI) is for general dental practices across the Central and Eastern Sydney PHN (CESPHN) region to participate in the Improving Oral Healthcare for People with Intellectual Disability Program.

This program aims to build confidence and capacity in caring for patients with intellectual disability, while supporting equitable access to preventative oral health care.

This program offers two education sessions, one quality improvement activity, and the option to select sensory regulation items to support patients to engage in oral health care.

For further information, please see the CESPHN website.

Applications are now open.

If you have any questions, please contact: intellectualdisability@cesphn.com.au

Applicant Details

1. General Practice details

Registered entity name

Trading name of organisation (if different from above)

ABN

Practice contact number

Email address

Is your general dental practice in the CESPHN region?

YesNoUnsure

2. Street Address

Street

City

State

Postcode

Postal Address

Leave blank if your postal address is the same as your residential address

Street

City

State

Postcode

3. Contact Person

The contact person is the person who will be involved in sharing information with the practice team and maintain ongoing communication with CESPHN staff.

Title

Please specify

First name

Surname

Preferred name

Position title

Contact number

Alternative number

5. Application Question

Please outline your interest in participating in the Improving Oral care Healthcare for People with Intellectual Disability program

Declaration

By submitting this form, I hereby agree:

I declare that all information provided in this application is true and correct.

I acknowledge, understand, and accept that this application does not create a legal or binding commitment, arrangement or understanding between CESPHN and the applicant organisation. Any such commitment, arrangement or understanding will be the subject of further negotiation and documentation. Additional specific conditions may be included in future agreements.

I acknowledge, understand, and accept that incomplete applications may not be considered.

I acknowledge, understand, and accept that information provided in this application will be stored by CESPHN in various formats including hard copy and/or electronic storage.

Name

Position

Date