You must download our forms to fill them in. We have help available if you use assistive technology or if you need a translator or interpreter. Find out how to use our forms.
Download and complete either the Word or PDF version of the:
- PBS/RPBS Safety Net prescription record form and application for a Safety Net card
- PBS/RPBS Safety Net prescription record form and application for a Safety Net card.
PBS is the Pharmaceutical Benefits Scheme.
RPBS is the Repatriation Pharmaceutical Benefits Scheme.
Page 1 of this form must be typed.
Each time you have a PBS/RPBS medicine supplied, hand both pages 1 and 2 of this form to the pharmacist.