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Anyone touched by Pulmonary Hypertension is invited to join PHA Australia. Under regulations set down by governement we are compelled to keep accurate records of membership. (Please see our Privacy Disclaimer for details)

Please Note:

Our membership database is currently under development pending introduction of our forums. You will not be able to login until the forums are activated.

Membership form PHA Australia

Thank You
Your form has been received.

* Compulsory information

* First Name

* Last Name

* Username

* Password

* Date of Birth

* Gender

Residential Address

* Street 1

Street 2

* City/Suburb

* State

* Postcode/Zip code

* Country

Postal Address

Copy from residential address

Street 1

Street 2

City/Suburb

State

Postcode/Zip code

Country

Telephone

Home

Work

Mobile

* Email

Information

If you could please answer the questions below as there are different types of "hypertension" and this may not be the right group for you. All being well we can swiftly have your application processed.

* What is your relationship to Pulmonary Hypertension?

Is it yourself? Your child? Other? Please explain.

* How were you diagnosed and when (date)?

* Do you know what type of PH/PAH you have? If so what classification or type of PH/PAH do you have?

(If you don’t know please state so)

* What hospital and Doctor is managing your PH?

* What medications / treatments are you on?

* Do you have any other conditions?

* If you or a family member does not have PH please explain why you would like to join.

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