The By-Name List

Please email us at test@test.com if your organisation is not listed in the Organisation list.

NSW Health pilot: new user application form

People participating in the NSW Health pilot of the by-name list can apply to join the system by completing the form below. This form should only be used by employees of the pilot Local Health Districts (LHDs).

When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.

First name *

Last name *

NSW Health email address *

NSW Health phone number *

Organisation *

Team name *

Role *

Manager approval

All NSW Health staff require management approval before they can use the NSW by-name list. By submitting this application, you are confirming that you have received approval from your manager to use the BNL. Please include the name, position, and email address of the manager that granted approval below. Your manager will be notified of your request to use the BNL via email.

Manager name *

Manager role *

Manager email *