Medicare Voluntary Indigenous Identifier

You can also identify by filling in the form below. You don’t have to do this. It’s your choice.

The details you give us help to shape government plans and policies and see if the policies are making a difference. Your information will be kept safe. It is protected by privacy rules and laws.

Follow these steps to identify.

1. complete your details below and print the page, or you can print the page and fill it in by hand
2. sign the form
3. send the completed form to:

Indigenous Access Program
Reply Paid 9822
in your capital city

Medicare number Fill in the first 9 numbers and then the number next to your name

Family name

First name

Other names

Date of birth

Gender

Male Female

I am of

Aboriginal descent Torres Strait Islander descent Both

Your postal address

Daytime phone number

Signature

Date

Please print this page, sign the form and mail it to us.

Submit