Register, amend or remove users for Aged Care Provider Portal form (AC004)

Use this form to register for, amend or remove access to the Aged Care Provider Portal.

Download and complete the Register, amend or remove users for Aged Care Provider Portal form.

An authorised person of the approved service must complete and sign this form.

Read more about the Aged Care Provider Portal.

This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.

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: 1 September 2020