Manual identity verification for Provider Digital Access form (HW080)
Use this form if you could not verify your identity online for your Provider Digital Access (PRODA) account or your name has changed.
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: 25 October 2018