Healthia Provider

Preferred Provider Application Form

If you wish to make a change to a provider from your practice or register as a new practice then please complete the form.

Click here for a guide on how to complete this form.

Please contact providers@tuh.com.au if you experience any issues completing the form or you have other enquiries.

By completing this form, you agree to the TUH Terms and Conditions and declaration in Section 2 linked below.

To view the Terms and Conditions please;

Click here if you are part of the TUH preferred provider network
Click here for general information for providers (fund rules etc.)

If you'd like to view how we collect and store your information you can view our privacy policy here.

Healthia

Provider application or new practice? *

Provider Application

New Practice

Please enter your practice email *

Do you want to add or remove a provider from your practice? *

Add

Remove

Is this provider Physio or Podiatry? *

Physio

Podiatry

Medicare Provider no. *

Practice Trading Name: *

Practice Legal Name: *

ABN: *

Website: *

Practice Managers Full name (including title): *

Phone: *

Practice email address: *

Street Address *

Suburb *

State *

Post Code *

Postal address: *

Medicare Provider No. *

Does your practice use either HICAPS or iSoft? If yes, please specify below.

HICAPS

iSoft

I acknowledge that:
a) I have received, read and agree to comply with the Terms and Conditions governing the TUH Preferred
Provider Network. I acknowledge that these Terms and Conditions will apply to the practice and its
providers from the date on which TUH accepts this application;
b) I understand that by submitting this application form to TUH I am applying for the practice and its providers
to join the TUH Preferred Provider network;
c) I understand that TUH may accept or reject this application at its sole and absolute discretion;
d) I understand that I (or another authorised representative of the practice) may withdraw this application at
any time before TUH notifies me that it has made a decision about whether to accept or reject it;
e) All the information I have provided to TUH with or in connection with this application form is true and
correct.

Authorisation: By checking the box, you agree to TUH T/C’s and the declaration in section 11 *

I Agree

Your full name: *

Official Capacity/Role: *

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Preferred Provider Application Form

Healthia

Join our network.