General practitioner 90 day pay doctor cheque scheme application form (HW074)

Use this form if you are a general practitioner registering for the General Practitioner 90 Day Pay Doctor Cheque Scheme.

Download and complete the General practitioner 90 day pay doctor cheque scheme application form.

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: 3 March 2022