Practitioner Indemnity Application Form

This application will take you approximately 15 minutes to complete.

You can return to this application at any stage by entering the details below.

New or existing application


1. Given names: *
2. Last name: *
3. Email: *
4. Date of birth: *


1. Given names: *
2. Last name: *
3. Email: *
4. Date of birth: *

To complete this application you will require:
- Your Australian Health Practitioners Regulatory Agency (Ahpra) registration number;
- Your Medicare provider number if claiming a Premium Support Scheme (PSS) subsidy;
- Details of your qualifications and professional associations;
- Details of any previous claims made against you;
- Details of any circumstances that you are aware of that may lead to a claim arising;
- Copy of your working visa, if applicable.

If you require any help completing the application contact Member Services on 1800 128 268. We are available between the hours of 8 am and 7 pm AEST. Monday-Friday.