Request for medical information form (CS4597)

Use this form to provide proof to support a request to change a child support assessment.

Download and complete the Request for medical information form.

Only a medical practitioner can complete this form and it is voluntary.

This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.

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 use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.

Page last updated: 10 December 2021