Young Stroke content creation application

Tell us about you

First Name

Last Name

Personal Email

Phone

I describe myself as a:

I am:

I identify as

(These questions are optional)

Aboriginal and/or Torres Strait Islander

LGBTQIA+

From a culturally and linguistically diverse background

Tell us about your content idea

My idea is

Hidden Use Only

	True
Bypass Validation Rules (Patient Contact)
Bypass Validation Rules (GP Contact)
Bypass Validation Rules (Carer/Next of Kin Contact)
Form Auto-Assign (Case)
Health Record (Contact)

Business Hours (Case)

Record Type ID (Case)

Young Stroke content Queue ID

Case Type (Case)

Case Origin (Case)

Subject (Case)

Body

Stroke Foundation’s Privacy Policy explains how we collect, use and take care of people’s personal information. For more about how we use personal information visit https://strokefoundation.org.au/privacy