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Get Health Improvement Benefit Approval Form

Purposes of this form means a Medical Practitioner, Dietitian, Exercise Physiologist, Physiotherapist, Osteopath, Chiropractor, Occupational Therapist, Psychologist, Diabetes Educator or Aboriginal Health Worker. This form lasts for a maximum of 2 years and will need to be renewed after that time. Patient details Who is this claim for? Member number First name Surname Health Provider details This section must be completed by the Health Provider recommending the exercise class or program. Nam.

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