Book call back - Health Professional requiring a direct call to their ClientNB: The National Continence Helpline is an advice and information line

Health Professional Details

Professional Type

Profession

Organisation

Health Professional First Name

Health Professional Last Name

Health Professional Postcode

Health Professional State

Please select your best contact number

Mobile Phone

Landline

Health Professional Email

Details of enquiry

Preferred date of call (Weekdays only)

IMPORTANT: Call backs cannot be scheduled for a weekend or a National Public Holiday.

Preferred time of call

IMPORTANT: All call times will be scheduled and made in Australian Eastern Standard Time (AEST).

Client Details

Choosing this option indicates that the client has consented to being directly contacted by the National Continence Helpline.

Client First Name

Client Last Name

Client Gender

Client Age

Please select the best contact number:

Client Mobile

Client Landline

Client Email

Further Details (relevant medical, surgical and continence history)