Practice incentives program health 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Medicare card number in the designated field. This is essential for identification purposes.
3. Fill in your personal details, including your title (Dr, Mr, Mrs, Miss, Ms), family name, first given name, and date of birth.
4. Indicate whether you agree to the practice submitting this form on your behalf by selecting 'Yes' or 'No'.
5. Provide the practice details such as Practice ID (if known), practice name, and full address including street number and suburb.
6. Read the privacy notice carefully and ensure you understand how your information will be used.
7. Complete the patient’s declaration by signing and dating the form. Ensure all required fields are filled out before submission.
8. Once completed, print the form and fax it to 1300 587 696 for processing.

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