Medicare enrolment form (MS004)

Use this form to enrol in Medicare for the first time, re-enrol in Medicare or enrol your newborn child in Medicare. This replaces the 3101 version of the form.

Complete and return your form

  1. Open the Medicare enrolment form, fill it in, print and sign it.
  2. Submit your form and supporting documents to us. The instructions are on the form.

You don’t need to complete this form for a newborn child enrolment if you chose to enrol them in Medicare when making a claim for Parental Leave Pay, Family Tax Benefit or Dad and Partner Pay.

Read more about how to add your newborn to your Medicare card as well as further information to consider when having a baby.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

This information was printed Thursday 23 May 2019 from https://www.humanservices.gov.au/individuals/forms/ms004 It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.

Page last updated: 13 February 2019