OUR PRENATAL MULTIVITAMIN IS AVAILABLE AT NO COST TO ELIGIBLE AUSTRALIAN CONCESSION CARDHOLDERS, ENSURING ESSENTIAL PRENATAL NUTRITION IS ACCESSIBLE TO EVERY INDIVIDUAL REGARDLESS OF INCOME, GEOGRAPHY OR CULTURAL BACKGROUND.

TO CONFIRM YOUR ELIGIBILITY, PLEASE HAVE YOUR SERVICES AUSTRALIA CUSTOMER REFERENCE NUMBER (CRN) READY.

SO THAT WE CAN BETTER UNDERSTAND AND SUPPORT THE INDIVIDUALS ACCESSING OUR SERVICE, PLEASE ENTER SOME DETAILS ABOUT YOURSELF.

PERSONAL INFO

1. FIRST NAME *

2. LAST NAME *

3. EMAIL ADDRESS *

4. DATE OF BIRTH

5. DO YOU IDENTIFY AS:

ABORIGINAL
TORRES STRAIT ISLANDER
NEITHER ABORIGINAL NOR TORRES STRAIT ISLANDER’

DELIVERY INFO

6. WHICH ADDRESS WOULD YOU LIKE YOUR PRENATAL MULTIVITAMINS DELIVERED TO?

YOUR PREGNANCY

7. HOW MANY WEEKS PREGNANT ARE YOU?

8. BEFORE RECEIVING LAND LAB SUPPLEMENTS, WERE YOU ALREADY TAKING PRENATAL VITAMINS?

IF NO, WHAT PREVENTED YOU?

COST
AVAILABILITY
DIDN'T KNOW I SHOULD BE TAKING THEM
NAUSEA
Other

9. HOW OFTEN DO YOU EAT FRESH FRUIT AND VEGETABLES?

DAILY
A FEW TIMES A WEEK
RARELY
NEVER

10. IS NAUSEA AND/OR VOMITING INTERFERING WITH YOU EATING FRESH FRUIT AND VEGETABLES?

YES, DAILY
YES, SOMETIMES
NO

11. DO YOU EXPERIENCE ANY BARRIERS TO ACCESSING FRESH FRUIT AND VEGETABLES?

IF YES, WHAT ARE THE BIGGEST CHALLENGES? (COST, TRANSPORTATION, AVAILABILITY, OTHER)

COST
TRANSPORTATION
AVAILABILITY
Other

12. HAVE YOU EVER BEEN TOLD BY A HEALTHCARE PROVIDER (E.G. DOCTOR OR MIDWIFE) THAT YOU HAVE ANY OF THE FOLLOWING

LOW IRON
LOW B12
LOW FOLATE
LOW VITAMIN D
NONE OF THE ABOVE

MORE INFORMATION

13. HOW DID YOU HEAR ABOUT THE LAND LAB PROGRAM?

GP
MIDWIFE
SOCIAL WORKER
COMMUNITY GROUP
FRIEND/FAMILY
ONLINE
Other

OUR MISSION IS TO SUPPORT PREGNANT AUSTRALIAN INDIVIDUALS WHO ARE EXPERIENCING FINANCIAL HARDSHIP.

TO ACCESS OUR SERVICE, YOU MUST HOLD A VALID GOVERNMENT-ISSUED CONCESSION CARD. TO CONFIRM ELIGIBILITY, WE KINDLY ASK FOR YOUR CONSENT TO VERIFY YOUR SERVICES AUSTRALIA CONCESSION CARD. YOUR PRIVACY IS IMPORTANT TO US, AND YOUR INFORMATION WILL ONLY BE USED FOR THIS PURPOSE.

CUSTOMER CONSENT

I authorise:

Land Lab to use Centrelink Confirmation eServices to perform a Centrelink enquiry of my Centrelink customer details and concession card status to enable the business to determine if I qualify for a prenatal supplement concession.
Services Australia to provide the results of that enquiry to Land Lab

I understand that:

Services Australia will disclose personal information to Land Lab including my name and concession card type and status to confirm my eligibility for relevant prenatal supplement concession.
This consent, once signed, remains valid while I am a customer of Land Lab unless I withdraw it by contacting Land Lab or Services Australia. I can get proof of my circumstances or details from Services Australia and provide it to Land Lab so they can determine my eligibility for relevant prenatal supplement concession.
If I withdraw my consent or don’t alternatively provide proof of my circumstances or details, I may not be eligible for the prenatal supplement concession provided by Land Lab.

I AGREE
I DISAGREE

PLEASE ENTER YOUR CENTRELINK REFERENCE NUMBER (CRN):

CONGRATULATIONS! YOU ARE ELIGIBLE FOR OUR LAND LAB PRENATAL PILOT PROGRAM.

WE ARE SO HAPPY TO HAVE THE OPPORTUNITY TO SUPPORT YOUR NUTRITIONAL NEEDS THROUGHOUT YOUR PREGNANCY AND BREASTFEEDING JOURNEY.

SOME WOMEN USING OUR SERVICE LIVE IN REMOTE AREAS OF AUSTRALIA WHERE POSTAL DELIVERIES ARE LESS FREQUENT. TO MAKE IT EASIER TO CONTINUE TAKING THEIR VITAMINS THROUGHOUT THEIR PREGNANCY WITHOUT GAPS, THEY OFTEN PREFER RECEIVING MULTIPLE MONTHS’ SUPPLY IN ONE ORDER.

HOW MANY MONTHS’ SUPPLY WOULD YOU PREFER EACH ORDER?

ONE MONTH
THREE MONTHS
SIX MONTHS

KEEP AN EYE OUT FOR YOUR LAND LAB DELIVERY AND START TAKING YOUR PRENATAL VITAMINS AS SOON AS YOU RECEIVE THEM!

A KEY ELIGIBILITY CRITERIA FOR ACCESSING OUR SERVICE IS HOLDING A GOVERNMENT-ISSUED CONCESSION CARD. UNFORTUNATELY, IF WE ARE UNABLE TO CONFIRM YOUR CONCESSION CARD STATUS, WE ARE UNABLE TO CONFIRM YOUR ELIGIBILITY.

IF YOU WOULD PREFER TO PROVIDE ALTERNATIVE PROOF OF YOUR CONCESSION STATUS, SUCH AS A PHOTO OF YOUR CONCESSION CARD OR A LETTER FROM SERVICES AUSTRALIA, FEEL FREE TO EMAIL US AT CARE@LAND-LAB.CO.

OTHERWISE, WE WISH YOU THE BEST OF LUCK WITH YOUR PREGNANCY AND WOULD LOVE THE OPPORTUNITY TO SUPPORT YOU IN THE FUTURE.

THANKS! WE WILL CONFIRM YOUR ELIGIBILITY AND BE IN TOUCH VIA EMAIL VERY SOON.

WE’RE REALLY LOOKING FORWARD TO SUPPORTING YOUR NUTRITIONAL NEEDS THROUGHOUT YOUR PREGNANCY AND BREASTFEEDING JOURNEY!

THANKS! WE WILL CONFIRM YOUR ELIGIBILITY AND BE IN TOUCH VIA EMAIL VERY SOON.

WE’RE REALLY LOOKING FORWARD TO SUPPORTING YOUR NUTRITIONAL NEEDS THROUGHOUT YOUR PREGNANCY AND BREASTFEEDING JOURNEY!

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