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F5. The Good, The Bad and the Ugly Practice Overview Benchmarking Questionnaire 2020 © Health & Life Access Pty Ltd 2020

It is very important that all requested information is issued to Health & Life at the same time.

Please visit Health & Life's website for more information, including our current terms of engagement. Should you proceed further, you understand that you accept the terms and conditions of our engagement.

If you do not accept our terms and conditions of our engagement, please call our office on (08) 8415 5400 or 1800 077 222

Contact details of an authorised person, lodging on behalf of the practice.

Full Name *

*

Email Address *

Practice Information Required

Please provide us with the following information (if applicable) relating to the 2019/2020 financial year.

Name of Practice(s). *

Practice Location(s).

Town/State

Is Health & Life the accountancy firm for your Practice(s)?

Yes

No

Would you give Health & Life the authority to contact your accountant?

Yes

No

Name of accountant/accountancy firm:

Email Address of accountant/accountancy firm.