Notification of premises where skin procedures are conducted

Use this form to inform the City of premises where skin penetration procedures are conducted.

Trading name of business*

ABN/ACN*

Business postal address*

Business premises address*

Suburb*

Postcode*

Daytime contact number*

Email*

Proprietor name*

Is the proprietor address different to the business address?*

YesNo

Date of commencement of operation*

Hours of operation*

Please attach a scale copy of premises floor plans showing the position of all fixtures and equipment*

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