Australian Thalidomide Survivors Support Program Health Care Assistance Fund form (PB300)

Use this form if you’re a recognised Australian thalidomide survivor, registered with the Australian Thalidomide Support Program.

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 Health Care Assistance Fund form.

This fund helps cover the out of pocket health care costs directly associated with thalidomide-related injuries. This may include any of the following:

  • health products and consumables
  • out of pocket pharmaceuticals
  • out of pocket health services, including medical, surgical and allied health
  • health-related travel and transport costs.

You need to provide documents to support your information. The form will tell you what documents to provide.

If you use assistive technology, you may not be able to access our forms. For help or information on completing the form, call the Thalidomide Support Service on 1800 643 787.

Page last updated: 24 June 2024.
QC 54196