Diverse Communities Project
Participant Details
First Name
Last Name
Personal Email
Phone
I am a:
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Survivor of stroke
Family member
Friend
Health care professional
I am from this community
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Arabic
Chinese-Cantonese
Chinese-Mandarin
Greek
Hindi
Italian
Korean
Vietnamese
Other community
State
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VIC
NSW
ACT
QLD
WA
SA
TAS
NT
Other/International
I consent to being contacted via email to receive project updates, information and invitations to participate.
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)
Diverse Community Queue ID
Case Type (Case)
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Diverse Communities Project
Case Origin (Case)
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Web
Subject (Case)
Body
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