GP Management Plan and Team Care ArrangementsThank you for taking the time to share some details regarding your healthcare. This helps us to formulate a useful and safe plan to help you achieve and maintain your best possible health. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Who is the doctor completing this plan for you? *Dr Lauren BarclayDr Tony BaylissDr Amin GayedDr Cath HesterDr Emma PhilipWhat are your current health concerns?What are your short term health goals (next 12 months)?What are your longer-term health goals (5+ years)?What types of physical activity do you like?e.g. gardening, running around after grandkids, dancing, walking, swimming, gym ... etc.Which other healthcare practitioners do you see/would you like to see?OptometristDentistDietitianPsychologistExercise physiologistDiabetes educatorPodiatristOther medical specialistOther allied healthOptometristEyecare Plus at KaraleeSpecsavers at RiverlinkSpecsavers at Redbank PlainsLaubman and Pank at RiverlinkEyes on BrassallOther optometristWhat is the name of the optometrist?Regular DentistKaralee Family DentalKarana Downs Family DentalLimstone Dental in IpswichBellbowrie Family DentalBrassal Medical CentrePring Street DentalOtherWhat is the name of the dentist?DietitianEat Smart NutritionHealthy Lifestyles Australia at RiverlinkOtherWhat is the name of your dietitian?PsychologistThe Long Gallery at MoggillLiley Place at IndooroopilyHappy Brain at BoovalBooval Specialist CentreRapha Health at SpringfieldThe Glow Room at KenmoreOtherWhat is the name of your psychologist?PodiatristIpswich Foot and AnkleChris Gardner at RaceviewKenmore PodiatryMy Foot DoctorOtherWhat is the name of your podiatrist?Exercise physiologistRamsay Health Plus IpswichKelly Luck at Target PhysiotherapyNaomi FersteraOtherWhat is the name of your exercise physiologist?PhysiotherapistTarget physiotherapyPhysioactive in IpswichIpswich Physiotherapy ClinicRamsay Health Plus IpswichOtherWhat is the name of your physiotherapistWhat is the name of your diabetes educator?Other regular medical specialistsOther allied health providersYour usual pharmacyKaralee ChemproKarana Downs pharmacyChemist Warehouse West IpswichChemist Warehouse Central IpswichPriceline Pharmacy RiverlinkJardin Pharmacy RiverlinkTerry White Chemart BelbowrieMoggill Village PharmacyOtherName of regular pharmacyYour usual pathology collection serviceMater Karana DownsS&N KaraleeS&N BelbowrieOtherName of regular pathology collection serviceWhat medical devices do you use?NoneCPAP machineBP monitorGlucometerHome oxygenSmart watchOtherOther medical devicesWould you like us to upload a Health Summary to your My Health Record?YesNoUnsure would like to discuss furtherSubmit
