Alis Expression of Interest | Aged Care Quality and Safety Commission

This registration is for:

Registered providers

Associated providers (you deliver aged care and services on behalf of a registered provider)

Entity/Provider name (if known)

Organisation and/or service name (include location if your organisation has multiple sites/locations)

Enter one of the following: Provider ID/Australian Business Number (ABN)/Australian Company Number (ACN). If unknown, enter N/A.

State or territory

Contact person full name

Position title

Telephone number

Organisation Address (Line 1)

Organisation Address (Line 2)

Suburb

Postcode

Details of one registered provider you work for

To get a free Alis account for associated providers, your organisation needs to deliver aged care and/or services for a registered provider. To verify this, we need to contact a registered provider you deliver aged care and/or services for.

You may work with more than one registered provider – please choose one and complete this section of the form with their details.

Name of registered provider you deliver care and/or services for

Include location if your organisation has multiple sites/locations

State or territory

Name of contact person at the registered provider

Include full name

Position title of contact person at the registered provider

Telephone number

Address of registered provider

Suburb

Postcode