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:
- Practice Incentives Program Indigenous Health Incentive - patient registration and consent form
- Practice Incentives Program Indigenous Health Incentive - patient registration and consent form.
Only use this form if your practice or Indigenous health service is already registered for the PIP IHI.
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: 16 July 2021
This information was printed 10 September 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/ip017. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.