Treatment prior financial approval request

Form ID: 
D1328
Audience: 
For providers
Chiropractor
Clinical psychologist
Dental prosthetist
Dental specialist
Dentist
Diabetes educator
Dietitian
Exercise physiologist
General Practitioner
Hospitals & day procedure centres
Medical specialist
Neuropsychologist
Occupational therapist (general)
Optometrist, Orthoptist and Optical dispenser
Orthotist
Osteopath
Physiotherapist
Podiatrist/Footwear prescriber
Psychologist
Social worker (mental health)
Speech pathologist

Used for requesting prior financial approval to provide medical and/or allied health services.

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?: 
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