Register, amend or remove users for Aged Care Provider Portal form (AC004)

Use this form to register for, amend or remove access to the Aged Care Provider Portal.

Download and complete the Register, amend or remove users for Aged Care Provider Portal form.

An authorised person of the approved service must complete and sign this form.

Read more about the Aged Care Provider Portal.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.

Page last updated: 17 November 2022