Subfoveal choroidal neovascularisation Initial PBS authority application form (PB072)

Use this form to apply for initial PBS subsidised treatment with aflibercept, ranibizumab or verteporfin for subfoveal choroidal neovascularisation.

If the need for treatment is urgent, you can fax the first authority application to the number on the form. The PBS Complex Drugs team will then call the prescriber.

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: 3 September 2018