Practice Incentives Program Indigenous Health Incentive patient registration and consent form (IP017)

Use this form to register an eligible Indigenous patient in the Practice Incentives Program (PIP) Indigenous Health Incentive (IHI).

Download and complete either the Word or the PDF version of the:

Only use this form if your practice or Indigenous health service is already registered for the PIP IHI.

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: 17 November 2023.
QC 20666