Medical Disclosure Authority (single practitioner)

Form ID
For providers
General Practitioner
Hospitals & day procedure centres
Medical specialist

This form allows clients to authorise a single medical practitioner, to disclose medical information to their Rehabilitation Provider and/or their DVA Rehabilitation Coordinator.

If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.

How can I access this form?
Form (PDF or Word)