This form should be submitted by pharmacists who:
The form must be resubmitted with updates if your details change (such as place of practice).
Note: After submitting the form, please email a copy of your general registration with the Pharmacy Board of Australia and the certificates of pharmacists training course(s) you have completed​ to ²Ñ°¿±á-³¦´Ç³¾³¾³Ü²Ô¾±³Ù²â±è³ó²¹°ù³¾²¹³¦²â²õ³¦´Ç±è±ð°ª³ó±ð²¹±ô³Ù³ó.²Ô²õ·É.²µ´Ç±¹.²¹³Ü​â¶Ä‹.
Use the subject line: "Intention to provide expanded community pharmacy services in ºÚÁϳԹÏÍø - Document copies". ​â¶Ä‹
​â¶Ä‹