Register for or amend a Location Specific Practice Number form (HW061)

Use this form to register for or amend your LSPN for diagnostic imaging premises or base for diagnostic imaging equipment.

Download and complete the Register for or amend a Location Specific Practice Number form.

A separate form is required for each practice location and must be signed by a proprietor or authorised representative.

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

You can upload this form in HPOS.

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: 20 February 2020