Forms

Membership

Application for membership
Dependant registration form
Membership amendment form
Contact information of dependants 18 years and older
Application for continuation of membership for pensioners
Application for continuation of membership following death
Ex gratia assistance
Member consent form
Affidavit for confirmation of income

Healthcare provider

Submit or change banking details for a medical practice

Authorisations

Chronic medication advance supply request form
Chronic Medicine Risk Management Programme application

Programme enrolment

Palliative care application form
HIV YourLife Programme application form
PMB Treatment Plan application form
Integrated care application form
Maternity Programme enrolment form