Medical Practitioner Acknowledgement

This form is used to help delegates understand the nature of the doctor-patient relationship, whether telehealth was used as part of the assessment and whether AI-assisted tools were used in preparing the assessment.

This form should be completed and submitted with compensation assessments when requested by DVA.

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.