And Pharmaceutical Benefits Scheme 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your personal details. Use a black or blue pen and print in BLOCK LETTERS. Ensure you mark the boxes clearly with a ✓.
3. In section 1, indicate your withdrawal from the PIP Indigenous Health Incentive and/or PBS Co-payment Measure by ticking all applicable boxes.
4. Provide your date of birth and Medicare card number in sections 3 and 4 respectively.
5. Complete the practice details in sections 5 to 7, including Practice ID, name, and full address.
6. Review your entries for accuracy, ensuring all required questions are answered before signing and dating the form.
7. Once completed, fax the form to 1300 587 696 as instructed.

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