Clinical Champions Registration

First name

Last name

Email

Contact number

Address

Suburb

State

Postcode

Role/Position

Organisation name

Organisation address

Suburb

State

Postcode

Type of organisation

Other (if above is selected)

Professional Qualification

Other (if above is selected)

Additional area(s) of specialisation

Please note
- Clinical and Community Champions operate in a voluntary capacity. In the event that we are funded to undertake co-design or collaboration, remuneration may be offered noting the same rate will be payable to our consumers and clinicians.

- In becoming a Clinical Champion, PANDA does not formally endorse you or your clinical skills, nor do we provide referrals to you or your organisation as a result of this role.

- It is acknowledged that Clinical Champions may be health practitioners that refer to or are referred to by PANDA, separate from this role.

I have read and acknowledged the above.

ART (i.e. IVF)	Birth Trauma
Breastfeeding	Disability - child
Disability - parent	Drug and alcohol
Existing medical conditions	Fertility issues
Obstetric complications	Peadiatrics
Premature baby

Antenatal Anxiety	Antenatal Depression
Aboriginal and Torres Strait Islander	Birth Trauma
Body image issues	Migrant and refugee background
Child and Family	Crisis intervention
Disability - child	Disability - parent
Eating Disorder	Grief/loss experience
Harm to infant	Intrusive thoughts
LGBTIQA+	Neurodiversity
Parent-child relationship	Perinatal Loss
Perinatal OCB	Physical trauma
Postnatal anxiety	Postnatal depression
Psychosis	Relational trauma
Self-harm	Suicidality

Aboriginal and Torres Strait Islander	Migrant and refugee background
Child protective services	Consumer engagement
Crisis intervention	Employment
Family services	Financial hardship
Homelessness/housing	Parent-child relationship
Refuge