Use this form to withdraw your consent to participate in the Practice Incentives Program (PIP) Indigenous Health Incentive (IHI).
You must download our forms and fill them in so they are processed quickly. You can also electronically sign some of our forms. We have help available if you use assistive technology.
Download and complete the Practice Incentives Program Indigenous Health Incentive patient withdrawal of consent form.
This form needs to be completed and signed by the patient withdrawing their consent from the PIP IHI.
This information was printed 3 January 2025 from https://www.servicesaustralia.gov.au/ip029. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/site-notices when using this material.