Prosthetic treatment request form

Use this form to request treatment for Transport Accident Commission and WorkSafe clients.

Published: 01 May 2014
File type: PDF
File size: 180.62 kB
Length: 3 pages
Reading level: Easy

What it contains

Blank form to complete information.

Personal and health information collected on this form is used to process, assess and manage claims under the Accident Compensation Act.