Use this form to withdraw your consent to participate in the Practice Incentives Program (PIP) Indigenous Health Incentive (IHI).
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 Practice Incentives Program Indigenous Health Incentive patient withdrawal of consent form.
This form needs to be completed and signed by the patient withdrawing their consent from the PIP IHI.
This information was printed 14 April 2026 from https://www.servicesaustralia.gov.au/ip029. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/site-notices when using this material.