Documents and Forms GMHBA Private Health Insurance Australia 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Provider Details. Fill in your Provider name, Provider numbers, and Specialty/s (Pathology and Radiology). If you know the Specialty code, include that as well. Don’t forget to add your Telephone number and Fax number.
3. Next, provide your Practice address and Postal address. Ensure these details are accurate for effective communication.
4. Enter your Email address carefully. Remember, only ISP registered email addresses can receive replies; avoid using internet-based emails like Yahoo or Hotmail.
5. For Direct Credit Payment Details, input the Name of Financial Institution, BSB Number, and Account Number accurately.
6. In the Contact Details section, specify a Contact name for account queries along with their Contact Telephone number.
7. Review the Provider Consent section. Indicate whether you consent to be included in the GMHBA Medical Gap provider list for brochures, website, and health practice management software by selecting 'Yes' or 'No'.
8. Finally, sign and date the form to complete your submission.

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