Free Interpreting Service application form for allied health professionals | Translating and Interpreting Service (TIS National)

* Indicates a required field

Allied Health Professional's Details

Profession/Occupation (e.g. Optometrist, Chiropractor)*

AHPRA number (input 'N/A' if not applicable)*

Please attach evidence of your current professional registration/membership/certification/accreditation.

Supporting documentation*

+ Attach more documents

Do you provide Medicare-rebatable services?*

Yes

Service type*

Privately owned practice

State/Territory government funded health service

Contact officer for application More information This is the person who is applying for free interpreting on behalf of your provider. They will be the contact person for this application.

Title

First name*

Surname*

Email address*

Phone number*If we need to contact you about your application we will contact you via email or this phone number. Phone number area code*

Alternate phone number Alternate phone number area code

Organisation's website address

Australian Business Number (ABN)

Registered Office/Clinic Address More information This is the street address of your provider or agency. Please include the building name, unit number, street number and street name.

Registered office/clinic name*

Building name

Street number

Street address*

Suburb*

State/Territory*

Postcode*

Local Government Area*

Primary Place of Service Provision

Please provide the address where you spend the most time delivering allied health services within an eligible Local Government Area LGA.

Same as above address?*

Yes

Do you have an existing TIS National client code?*

Yes

Not sure

Please include any additional information to support your application

I certify that I am authorised to provide the information contained in this application form and certify that it is true and accurate*

Yes, I am authorised to provide the information contained in this application form and it is true and accurate

It is understood that by submitting this application form, the provider is agreeing to abide by the free interpreting service terms and conditions upon being approved to use the Free Interpreting Service under the allied health category*

Yes, I/the provider agree/s to abide by the Free Interpreting Service terms and conditions upon being approved to use the Free Interpreting Service under the allied health category

I have read and understood the department’s privacy statement* Yes, I have read the privacy statement

I have read and understood the department’s security statement* Yes, I have read the security statement

I have read and understood the department’s terms and conditions* Yes, I have read the terms and conditions

Jurisdiction	LGA
ACT	Canberra
NSW	Fairfield, Liverpool, Blacktown, Albury, Armidale, Coffs Harbour, Newcastle, Wagga Wagga, Wollongong
NT	Darwin
QLD	Brisbane, Logan, Cairns, Gold Coast, Toowoomba, Townsville
SA	Adelaide, Mount Gambier
TAS	Launceston, Hobart
VIC	Casey, Greater Dandenong, Hume, Wyndham, Brimbank, Melton, Greater Geelong, Greater Shepparton, Mildura, Wodonga
WA	Perth