Medicare Voluntary Indigenous Identifier

You can also identify by filling in the form below. You don’t have to do this. It’s your choice.

The details you give us help to shape government plans and policies and see if the policies are making a difference. Your information will be kept safe. It is protected by privacy rules and laws.

Follow these steps to identify.

complete your details below and print the page, or you can print the page and fill it in by hand
sign the form
send the completed form to:

Indigenous Access Program
Reply Paid 9822
in your capital city

Medicare number

Family name

First name

Other names

Date of birth

Gender

Male

Female

I am of

Aboriginal descent

Torres Strait Islander descent

Both

Your postal address

Daytime phone number

Signature

Date

Medicare Voluntary Indigenous Identifier

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