Remove Doctor

Online Application
Remove Doctor

When you reach the end of the form please take note of the instructions detailing how to submit your application.

If you get stuck or have any questions please don't hesitate to contact us.

Online Application
Remove Doctor

At Medical-Objects, your security and privacy are our top priorities. To ensure a seamless and secure experience for all our users, we kindly request that you provide valid email address for your practice before proceeding with the form.

Thank you. A confirmation email has been sent to the address you provided. Kindly check your inbox and follow the instructions provided to complete the verification process. If you do not see the email in your inbox, please remember to check your spam or junk folder.

Practice Details

Practice Details

Mailing Address

Providers Details

Providers Details

Providers

Name Job Title Job Class Medicare Provider HPI-I Default Remove
Default Location

Provider numbers are location specific by Medicare. If you move practices your provider number will remain at the assigned location for outstanding results for 12 months. If you wish to change the location, we will require an agreed notice from you and the practice before relocating the provider number.

Default Receiver

Any additional notes you'd like to submit.

Error, files must be of the following type: xls or xlsx.
Error, file limit is 1 file, no bigger than 2MB.

Authorisation

Authorisation

Terms and Conditions

Medical-Objects agrees to adhere to all Privacy Act 1988 (Commonwealth) (“the Act”) and the Australian Privacy Principles (“APPs”) and any other applicable privacy laws that govern how private sector Health Service providers handle your personal information (inclusive of sensitive information and Health Information). Please read the Medical-Objects Privacy Policy located www.medicalobjects.com/privacy.

I understand and accept this agreement with the knowledge that Medical-Objects Pty Ltd will be using the personal information provided by me on this form in order to supply Medical-Objects Health Software Products and Services and not for unsolicited communication or marketing. I understand and accept that Medical-Objects products, services and personal information will be used by us for managing healthcare information, services and communications only. I understand that it is our responsibility to provide adequate security to protect personal and sensitive information located on our premises.

I understand that software support covers Medical-Objects products and services only. I agree to the Medical-Objects terms and conditions found at www.medicalobjects.com/MedicalObjectsSLA.pdf. I understand the Medical-Objects Refund Policy found at www.medicalobjects.com/refund-policy. I agree to notify Medical-Objects Pty Ltd of any problems or errors and to provide feedback directly.



This website uses GeoNames for address lookups, under a Creative Commons Attribution 4.0 License

Authorisation is required.
Please print, sign and send to Medical-Objects.

We have also emailed a copy of your draft application to your email provided (N/A).

If you do not receive the e-mail please check your spam or junk folder. If you still did not receive it please contact us and quote your application ID: .

If you want to print a copy of your application click here.

Your submission has been successful.

Your form has been submitted. A confirmation e-mail has been sent to N/A.

Please allow up to 48 hours for us to complete your request.

If you do not receive the e-mail please check your spam or junk folder. If you still did not receive it please contact us and quote your application ID: .

If you wish, you can save a copy of the form and close this window now.