Better health and ageing for all Australians

Information for Providers

Hearing Services Forms

This page provides a list of all forms used under the Australian Government Hearing Services Program

In this section:

Client Forms

Voucher Application and Eligibility Forms

  • New Client Voucher Application Form (PDF 114 KB)
  • DVA Maintenance Eligibility Form (Latest Version) (PDF 68 KB)
  • Eligibility Confirmation Form (September 2008) (PDF 117 KB)

    Claiming

    Claims Forms

  • Manual Claim for Payment Form (PDF 63 KB)
  • Manual Claim Payment Attachment (PDF 36 KB)
  • Spare Aid Form
  • Remote Control Requirement Form

    Clinical

    Device and Fitting Forms

  • Refiting Guidelines
  • Refit Approval Request Form
  • Other Clinical Scenario Guidelines (PDF 25 KB)
  • Spare Aid Form
  • Statutory Declaration for Replacing Lost Aids (PDF 17 KB)
  • Request to Fit a Non-Standard Device

    Other Clinical Forms

  • OHS Complex Client Notification (Private Provider)
  • File Request (for return Voucher and Authorised Relocating Clients) (PDF 27 KB)
  • Request for Voucher within 2 Years

    Voucher Forms

  • Urgent Voucher Request Form (September 2008) (PDF 32 KB)
  • Voucher Verification Request Form (September 2008) (PDF 195 KB)

    Service Provider Administration

    Audiologist and Audiometrist Application Forms

  • Application for Approval as a Qualified Practitioner (PDF 69 KB) Once the form has been completed please print out to sign.
  • Application for Provisional Registration (PDF 69 KB) Once the form has been completed please print out to sign.
  • Application for Registration as a Student Audiometrist (PDF 64 KB) Once the form has been completed please print out to sign.

    Service Provider Forms

  • Ambient Noise Level Certification Exemption Form (PDF 54 KB) Once the form has been completed please print out to sign.
  • Change of Client Details (September 2008 replaces change of client name form) (PDF 193 KB)
  • New Site (PDF 62 KB) Once the form has been completed please print out to sign.
  • Site Amendment (PDF 62 KB) Once the form has been completed please print out to sign.
  • Closed Site (PDF 59 KB) Once the form has been completed please print out to sign.
  • Notification of Practitioners and Referral Audiologists (PDF 72 KB) Once the form has been completed please print out to sign.


    If you are unable to download any of the forms above please send an email to ohsweb@health.gov.au and a copy will be provided.

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