Application for Reimbursement of Medical Expenses

Use this form to get reimbursed for out-of-pocket medical expenses, including:

• Specialist consults, such as surgeon consults, and MRI and PET scans
• Doctors and allied health services such as GP, physiotherapist, dentist and podiatrist
• Imaging and pathology e.g. x-rays, scans and blood tests
• Hospital costs e.g. private room, day procedure
• Pharmaceuticals such as full-cost prescription and non-prescription items
• Aids, appliances and home modifications such as dressings, knee brace and compression garments
• Accounts reimbursed by Medicare or private health insurance.

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.

What you’ll need

To assist the process of your claim, please make sure all accounts have been paid in full and evidence of receipts are provided with your application.