Better health and ageing for all Australians

Hearing Professionals Forms and Publications

Sites and Practitioner Forms

Application, Practitioner and Site Forms for Hearing Service Providers.

Electronic Forms

The following forms have been designed for ease of use and increased efficiency. Please complete the forms on-screen and either save to your computer and attach to an e-mail, or click on the “Submit” button to create an e-mail with the form attached.

Please ensure all fields are completed including Contractor Number and Name, Authorised Person and confirmation e-mail, and that all certification boxes are ticked.

Notice to Practitioners
The processing of site amendment forms closed on 22 February 2013 to allow for the migration of data to the new online portal (Hearing Services Online project - CSPN 2012/34). Following the release of the new online portal, Service Providers will be able to maintain and update their own site information.

New Site Notification

This form is used to notify the Office of Hearing Services (the Office) of a new Site where services will be provided to Hearing Services Program clients.
Link to:Printable PDF Version New Site Notification Form (PDF 91 KB).
Link to:Word Version New Site Notification Form (Word 57 KB).

Site Closure

This form is used to notify the Office that services will no longer be provided at a Site. This form must be submitted a minimum of 10 working days before the date of closure.
Link to:Printable PDF Version Site Closure Form (PDF 60 KB)
Link to:Word Version Site Closure Form (Word 54 KB)

Notification of New Provisional Practitioner

This form is used to list a hearing practitioner as a Provisional Audiometrist or Provisional Audiologist with the Office.
Link to:Printable PDF Version Notification of New Provisional Practitioner Form. (PDF 62 KB)
Link to:Word Version Notification of New Provisional Practitioner Form (Word 57 KB)

Request for Qualified Practitioner Number

This form is used to gain a Qualified Practitioner Number for a hearing practitioner who has met the requirements to be listed as a Qualified Practitioner (Audiometrist) or Qualified Practitioner (Audiologist) with the Office.
Link to:Printable PDF Version Request for Qualified Practitioner Number Form (PDF 63 KB).
Link to:Word Version Request for Qualified Practitioner Number Form (Word 51 KB)

Notification of Practitioners and Referral Audiologists

This form is used to notify the Office of previously listed Provisional or Qualified practitioners who have commenced or ceased employment with a Contracted Service Provider.
Link to:Printable PDF Version Notification of Practitioners and Referral Audiologists Form. (PDF 67 KB)
Link to:Word Version Notification of Practitioners and Referral Audiologists Form. (Word 71 KB)

Read more: Hearing Services Program Contacts
Read more: Hearing Professionals Forms and Publications

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