Application for a Medicare provider number and, or prescriber number for allied health and non-medical health professionals form (HW093)

Use this form if you are applying for an initial or subsequent Medicare provider number or a PBS prescriber number or both.

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: 31 July 2019