Factsheets and Forms

Forms for clients

Medical certificate

If you are a new client to the program, this form must be completed by your medical practitioner. Once complete please take it to your hearing services provider to finalise your application.

Medical Certificate (PDF)
Medical Certificate (Word)

Client application form

You can apply for the program online, through a service provider or on a paper application form.

Apply online today - this is the quickest way, you will be told in a few minutes if you are eligible.  You will be sent a welcome pack to the program, and a medical certificate which you need to get your general practitioner to complete.

A service provider can also help you apply for the program. You will need to take a completed medical certificate with you. 

Or you can download the paper application form below, to print out and complete, and send it to the hearing services program to process your application. 
Client application form (PDF)
Client application form (Word)

Reconsideration and appeals form

People who are affected by and dissatisfied with certain decisions made by the program are able to request a reconsideration. A request for reconsideration can only be made in very specific circumstances. You can find more information about reconsideration requests on our website.

Reconsideration and Appeals Form (PDF)
Reconsideration and Appeals Form (Word)

Factsheets about the program

Factsheets regarding eligibility for the program, accessing and providing feedback about services received the program, and more general information can be found in this section.

Factsheets about services available to me through the program

You can read more about the hearing services available through the program in these factsheets.

Factsheets about the hearing devices available through the program

Factsheets relating to the hearing devices available through the program can be found in this section. 

Contacting the Department of Health and other Agencies (pdf)