Medicare Safety Net Registration and Amendment for Couples and Families form (MS016)

Use this form to register or amend your family's details for the Medicare Safety Net.

Download and complete the Medicare Safety Net Registration and Amendment for Couples and Families form.

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, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 20 February 2020