Subfoveal choroidal neovascularisation Initial PBS authority application form (PB072)

Use this form to apply for initial PBS subsidised aflibercept, ranibizumab or verteporfin treatment for a patient with subfoveal choroidal neovascularisation due to age related macular degeneration.

 
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 October 2017