Verification of medical conditions form (SU684)

Use this form to provide details of your medical conditions. We’ll use this information to conduct an Employment Services Assessment.

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 the Verification of medical conditions form.

Only a medical practitioner, registered nurse, nurse practitioner or Aboriginal and Torres Strait Islander health practitioner can complete this form.

If they didn’t diagnose your medical condition, they must include the name of the medical practitioner who did.

This isn’t a medical certificate. If you need a temporary exemption from your mutual obligation, participation or study requirements, you can read about getting a medical certificate.

Page last updated: 28 November 2025.
QC 19796