Register for or amend a Location Specific Practice Number form (HW061)

Use this form to register for or amend your LSPN for diagnostic imaging premises or base for diagnostic imaging equipment.

A separate form is required for each practice location and must be signed by a proprietor or authorised representative.

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: 2 July 2019

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