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Griffith Rehabilitation Hospital
Please complete the details below to express your interest in participating in the Private Hospital clinic for polio survivors.
What start date would you prefer for the clinic?
I am interested, but unable to attend in January
How many days would you prefer to attend the clinic?
I give consent to Polio Australia sharing my contact details to Griffith Rehabilitation Hospital regarding this program
Thank you for taking the time to complete these details. Your interest in this trial project is an important step in securing a polio-specific private clinic option in Adelaide.
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This form was created inside of Polio Australia Incorporated.