Contact a GP 1Clinic Info2My Info3RACF Info4Submit Medical Clinic(Required)Select ClinicFederation ClinicWodonga West Medical ClinicClinic Phone(Required)Medical Clinic Email(Required) HiddenDate and Time Download Form Dear Doctors, I am about to move into permanent accommodation at the Residential Aged Care Facility identified below. I am relocating to a Residential Aged Care Facility becauseMedical IssuesMy usual GP does not visit patients at this RACF. I am therefore respectfully requesting your services to be my regular General Practitioner. Yours sincerely,Full Name(Required) Enduring Power of Attorney Date of Birth(Required) DD slash MM slash YYYY Enduring Power of Attorney PhoneMedicare No. Pension No. DVA No. I am currently living at Home Hospital I can be contacted:Phone(Required)Email Hospital Support Person Hospital PhoneHospital Email My Future RACF(Required) Wing/Room Details Address(Required) Street Address Address Line 2 City State Australian Capital TerritoryNorthern TerritoryNew South WalesQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Postcode RACF Phone(Required)Expected Date of Transition(Required) DD slash MM slash YYYY RACF email RACF Contact Person(Required) You are About to Submit the Form Please make sure you’ve reviewed your form, confirmed all details are correct before hitting the submit button. A copy of the form will be sent to your email.