Application for recognition as a General Practitioner Fellow of the Australian College of Rural and 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your provider number in the designated field. This is essential for Medicare purposes.
3. Fill in your personal details, including your family name, first given name, second given name, and select your title (Dr, Mr, Mrs, Ms, Miss).
4. Indicate your sex by selecting either Male or Female.
5. Provide your date of birth in the specified format and ensure you enter your postal address accurately.
6. Complete the contact information section with your daytime phone number and mobile phone number. You can also indicate if these are preferred contact details.
7. Review all sections to ensure completeness. Sign and date the form before submission.

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