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Priorities for Endometriosis in Australia
We invite representatives across the endometriosis and pelvic pain sectors to share their insights into the priorities for addressing endometriosis in Australia. Your feedback will help form our strategy and list of priorities to inform the Australian and State Governments.
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Email
*
Your email
Your Name
*
Your answer
Post code
*
Your answer
Phone Number
*
Your answer
Email Address
Your answer
Which of the following best describes your role?
Consumer
Organisation Representative
Sector Representative
Researcher
Clinician
Health Professional
Government Representative
Which of these options describe you? I am... (please select all that apply)
Woman or girl
Man or boy
a First Nations Australian
a culturally and/or linguistically diverse person
a person with disability
transgender or gender diverse
Non-binary
intersex
lesbian, gay, bisexual, queer or other diverse sexuality
homeless or at risk of homelessness
a person who has experienced violence and/or abuse
none of the above
I prefer another term
Prefer not to say
Other:
Is English the primary language spoken at home?
Yes
No
Prefer not to say
Occupation (if applicable)
Your answer
Organisation you are representing (if applicable):
Your answer
Professional Qualifications (if applicable)
Your answer
Priorities
Priority 1:
Your answer
Priority 2:
Your answer
Priority 3:
Your answer
Priority 4:
Your answer
Priority 5:
Your answer
Share details about your interest in endometriosis and pelvic pain:
Your answer
Are you interested in contributing to the peak body for endometriosis and pelvic pain in Australia to assist in advocating for the agreed priorities? If yes, share details below:
Your answer
How can ACE assist you/your organisation in achieving improvement in Australia for people living with endometriosis and pelvic pain?
Your answer
I hereby declare that the information provided in this application is true and accurate to the best of my knowledge and I consent to be contacted regarding my feedback and ongoing updates.
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(electronically sign below with your full name and date).
Your answer
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