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MyMedicare Registration Form

MyMedicare is a voluntary patient-registration model, designed to formalise the relationship between you, your general practice, your GP and your wider primary care team.

As a MyMedicare patient, you and your regular GP will gain access to enhanced benefits—helping deliver the care you need and ultimately improving health outcomes.

Once complete, please provide this registration form to your preferred general practice to finalise your enrolment.

Patient Details
Practice & Provider
Consent & Signature

By signing this form I agree to the following:

  1. I understand that registering in MyMedicare is voluntary.
  2. I consider this Practice to be my regular primary health care provider.
  3. I understand that I can only be registered with one Practice at a time. By submitting this form, any existing registration will be withdrawn, and my previous Practice will be notified.
  4. I will remain registered unless:
    • I register with a different Practice.
    • I request withdrawal of my registration.
    • My GP or Practice decides to withdraw my registration.
  5. There is no cost to register in MyMedicare.
  6. I have read and understand the MyMedicare Privacy Notice and consent to my information being shared with relevant agencies as specified.
  7. I can register even if I don’t complete the ‘About You’ section.
If a parent/guardian completes this for a 14–17 year-old, confirm the patient is aware and has consented. Yes
Registration for under-14s must be consented by a parent or legal guardian.
Providing this information is voluntary.
About you

The information you provide will help your practice and the government to plan and improve your health care services. We will share this information with your MyMedicare practice. If you choose not to provide this information as part of your registration, you will still be able to register for MyMedicare. You may still provide this additional information about you directly to your practice. We may already have your information if you have registered in the past.

(May differ from sex recorded at birth or legal docs)
Only complete if aged 15 years or over.
  • A. Daily activities (washing, dressing, walking, speaking):
  • B. Independent living (shopping, cooking, decision-making):
  • C. Work, education, community living:
Office Use Only

Please select a box to confirm the patient’s eligibility:

The patient meets one of the exemption criteria:

The practice will retain a copy of this Registration Form in the patient’s clinical records, for compliance with record-keeping obligations under Federal, State and Territory legislation.

Privacy Statement

The law regulates how Services Australia, the Department of Health and Aged Care, the Australian Digital Health Agency and the Department of Veterans’ Affairs may handle your personal information. Services Australia is collecting your personal information to assess your eligibility for MyMedicare and provide linked services and payments. Your information will only be shared with relevant agencies where you have agreed or where the law allows. See the MyMedicare Privacy Notice for full details.

You can also read the: