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.

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 Monday 27 May 2019 from https://www.humanservices.gov.au/individuals/forms/sa472 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: 10 April 2019