Consent to disclose medical information form (SA472)

Use this form to confirm that you consent to your treating health providers disclosing relevant information about your disability or medical conditions to us.

This form is used to support your claim for Disability Support Pension form.

A translated version of this consent form may be available in your language.

Page last updated: 25 August 2016

This information was printed Wednesday 28 September 2016 from humanservices.gov.au/customer/forms/sa472 It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.