Data submitted through the following form will be used solely by the Department of Health and will not be used or disclosed for any other purpose.
Users should note there are inherent risks associated with transmission of information via the Internet.
You should be aware that any information transmitted to this site via the Internet may be viewed by persons without the authority of the Commonwealth.
Therefore users should make their own assessment of the potential risks to the security of their information when making a decision as to whether or not they should use this facility.
Please note there are alternative ways to submit form data to the Department of Health for those users who do not wish to use public networks such as the Internet, these are provided at the bottom of this page.
By submitting this form, you acknowledge and agree that:
- The Commonwealth will not be liable for any unauthorised access or for any loss or damage which you may incur as a result of any unauthorised access to this site or information transmitted by you or any other person.
It is a criminal offence:
- to intentionally obtain access to data stored in a Commonwealth computer without the authority of the Commonwealth;
- subject to the Telecommunications Act (Interception) 1979 to intercept a communication passing over a telecommunication system.
- to give false or misleading information to a Commonwealth entity.