Follow the steps to complete your registration form

1. Press the ‘Get Form’ button to obtain the AU Synergy Life Support Equipment Registration form and open it in your chosen editor.
2. In Section 1, enter your details as the applicant. This includes your Synergy account number, meter number, full name, date of birth, supply address, postal address (if different), and contact information.
3. In Section 2, indicate if you are also the patient requiring life support equipment. If not, provide the patient's details, including their full name, date of birth, relationship to you, and the address where the equipment will be used.
4. Proceed to Section 3, where you will declare your authority to act on the patient’s behalf (if applicable) and confirm that all provided information is accurate. Sign and date the declaration.
5. Complete Section 4, focusing on medical authorization. This section must be filled out by a qualified medical practitioner. Ensure they provide their name, registration number, and details of the life support equipment prescribed.
6. In Section 4, the medical practitioner should indicate which life support equipment is required by selecting the appropriate options for each type listed.
7. After filling in all required fields, ensure that the form is complete. If necessary, scan the filled form and prepare it for submission.
8. Submit your completed application by mailing it to the provided address, using the Reply Paid envelope, or sending it online as an attachment.
9. Lastly, ensure you save, download, or print a copy of your application for your records before submitting.

Complete your AU Synergy Life Support Equipment Registration online today to ensure your needs are promptly addressed.