Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Complete Section A: Customer Details. Fill in your details including title, surname, first name, address, postcode, and telephone number for the residential address nominated for Priority Assistance. If you are completing the form on behalf of the customer, provide your details as the Customer Representative.
3. In Section B: Privacy Consent, ensure that the patient, who may not necessarily be the Account Holder, or their Customer Representative signs the consent to allow Telstra to collect and disclose medical information for the application.
4. Proceed to Section C: Medical Condition Confirmation. You must complete either Section C1, which requires a doctor to confirm the medical condition, or Section C2, a statutory declaration that you or someone living in your household has a life-threatening medical condition.
5. In Section C1, have your Medical Practitioner fill out their details and confirm your eligibility based on the prescribed criteria. If you are completing Section C2, make the required statutory declaration in front of an authorized witness.
6. Review all sections for completeness and ensure all signatures are present. Only after all sections are completed and signed can the application be processed.
7. Once the form is complete, you can save the changes, download the document, print it, or share it as needed.

Complete your Priority Assistance Application Form online today for timely processing.