Registration for a Location Specific Practice Number form (HW061)

Use this form to register for a 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 form can be uploaded through HPOS. Read more about form upload in HPOS.
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

Page last updated: 1 July 2018