Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by reviewing the eligibility criteria in Part A. Ensure you meet the requirements before filling in the details.
3. In Part B, fill in your personal details including your name, date of birth, gender, and Medicare card number. Make sure to provide a contact number and email address.
4. If applicable, provide details regarding your concession card in question 7. This includes your concession card number and expiry date.
5. In Part C, input referral details only if this is your first application for assistance to this practitioner or health service or if you have not submitted a referral in the last two years.
6. Complete Part D by providing an air approval code if you plan to travel by commercial air. Ensure your practitioner has obtained the necessary approval.
7. In Part E, indicate the type of treatment you received and fill in the treatment details. Be sure to note the hospitalization status if it applies.
8. Provide your bank account details in Part F for payment purposes, specifying if you wish for a third party to receive part of your subsidy.
9. In Part G, fill in the travel and accommodation details including travel dates and modes of travel. If staying overnight, provide the necessary accommodation details.
10. Finally, complete Part H with your patient declaration to confirm the information provided is complete and correct.
11. After filling in all required fields, review your application thoroughly. Ensure all sections are completed before submitting.
12. Save changes, and consider downloading or printing the completed form for your records.

Start your application online now to access travel and accommodation assistance.