MCC PNG

New health premises pre-application form

Please ensure you upload a copy of your floor plans with this application.

When we receive your application, we will invoice you for payment of the appropriate fee.

If you have any queries please contact Maroondah City Council’s Community Health team on 9294 5603.

* denotes mandatory

Location of premises
Address *
Suburb *
Postcode *

Proprietor details
Primary contact person name *
Phone number *
Email
Business trading name
Proprietor/Company
Business postal address
Suburb
State
Post code
Business phone
Business mobile
Business email

Trading details
Proposed date of opening
Date
Type of premises *
Do you plan to offer mobile services (not permitted for skin penetration activities) *
Do you intend to sell food or drinks (including packaged food)? *

Types of treatment undertaken

Copy of plans

Fixed beauty and hairdressing will need to submit floor plans. Mobile beauty and hairdressing only need to submit photos of their equipment/kit.
Your floor plans should include:
  • Hand washing facilities
  • Toilet/bathroom facilities
  • Kitchenette sink and equipment wash up sink 
  • Waste water disposal area
  • Treatment rooms/ stations
  • Surface finishes of all walls, floors, ceilings and work areas
Upload a copy of your plans *

Pre-application fee

You will be invoiced the appropriate fee on receipt of this application.

Once we have received payment, we will process your pre-application and will contact you.

  • $180 - High risk - Tatooing, body and dermal piercing, permanent make-up (cosmetic tatooing), colonic irrigation, electrolysis, dry needling
  • $180 - Medium risk - waxing, laser, threading, manicure, pedicure, facials, eyelash extensions, microdermabrasion, ear piercing
  • $180 - Low Risk - hairdressing, temporary make-up

Your privacy 

Maroondah City Council is committed to protecting your privacy as prescribed by the Privacy & Data Protection Act 2014 and the Health Records Act 2001.  The information you provide on this form is being collected by Maroondah City Council for the strict purpose of conducting Council business.  Your information will not be disclosed to any external party without your consent, unless Council is required or authorised to do so by law.  Failure to provide the information requested may make you ineligible to receive the service or be part of an event/function that is the subject of this form.  Any access to the information, amendments that may be required or any privacy enquiries may be directed to Council’s Privacy Officer & Health Records Officer on 9298 4211 or email privacy@maroondah.vic.gov.au
 
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