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What is your postcode?
   
 
 
 
What is the highest level of education you have completed?
 
Primary school
 
Year 10 or equivalent
 
Year 12 or equivalent
 
Certificate
 
Diploma
 
Bachelor Degree
 
Graduate Diploma or Certificate
 
Postgraduate Degree
 
 
 
Does your child have siblings?
 
Yes
 
No
 
 
 
How many younger siblings does your child have?
   
 
 
 
How many older siblings does your child have?
   
 
 
 
Which clinic is your child attending today?
 
Allergy
 
Diabetes
 
Endocrinology
 
Cystic Fibrosis
 
Gastroenterology
 
General Paediatrics
 
Neonatology
 
Neurology
 
Pain
 
Rehabilitation
 
Respiratory
 
Surgery
 
Orthopaedics
 
 
 
What is your child's gender?
 
Male
 
Female
 
 
 
What is your child's date of birth?
 
 
 
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