Ohcwa form 14 2026

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The document is an application form for dental treatment and consent at the Oral Health Centre of Western Australia (OHCWA). It requires personal information from the patient, including name, date of birth, and eligibility details related to Centrelink benefits. The form outlines the process for confirming eligibility for subsidized dental treatment and includes sections for customer consent and income confirmation. Patients must complete both declarations to receive treatment.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Given Name and Surname in the designated fields. Ensure that you write clearly, as this information is crucial for identification.
Fill in your Date of Birth (DOB) and Temperature (TEMP) in the respective sections. This data helps assess your eligibility for dental treatment.
Indicate your gender by selecting Male or Female, and provide your First Language and Country of Birth to assist with communication needs.
Complete the section regarding the person responsible for payment, including their name, address, and contact details. This ensures proper billing procedures.
In the Eligibility Information section, review the requirements carefully. Make sure to check if you hold a Healthcare Card or Pension Concession Card for subsidized treatment.
Sign the Customer Consent and Income Confirmation sections at the end of the form. This authorizes Centrelink to share necessary information with OHCWA.

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Versions	Form popularity	Fillable & printable
2023	4.9 Satisfied (43 Votes)
2007	4 Satisfied (35 Votes)

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