Upload Document(s)

Use this facility to submit additional documents relating to your application and/or submit a completed PDF form and supporting documents.
IMPORTANT: Additional information provided in support of a previously submitted application to supply pharmaceutical benefits, that has not been requested by the Department or provided at the time of application submission will not be considered or placed on your application file.

Contact Details

First name

Last name

Phone number

Upload Details

Category

Sub-category

Is the form for an Existing Application or an Approved Pharmacy?

Existing ApplicationApproved Pharmacy

Reference number

e.g. PBS tracking number, Application number, Approval number, Provider number

Description

Provide a brief description of the attached documents and any other relevant details.

Generate a new image Play the audio code

Enter the code from the image