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.

Page last updated: 9 April 2018