Forms
Most requested provider forms
- Certificate of capacity
- Provider registration for health and service providers
- Provider registration for disability providers
- Allied Health Treatment and Recovery Plan (AHTRP)
- Mental Health (social work, psychology and neuropsychology) Treatment Plan
- Authority to release information
- Dental report
- Funeral and dependency benefits claim form
- Update provider bank details
Forms
Above Rate Service Agreement
Find out how to apply and get more information about TAC Above Rate Service Agreement. Read and fill up the form regarding your service agreement.
Allied Health Treatment and Recovery Plan
Check out the Allied Health Treatment and Recovery Plan to aid in your rehabilitation journey. Contact TAC to learn more about the plan and its benefits.
Assistive technology assessment and recommendations
TAC offers assistive technology assessments for injury-related needs with required solutions and resources to aid recovery. Contact us for further details.
Attendant Care Overnight Task Log
Learn about TAC's Attendant Care Overnight Task Log and how it helps manage care services. Contact TAC for details on filling out the log and its usage.
Audiology - Hearing assessment and device request form
Get the Audiology Hearing Assessment and Device Request Form for clients. Submit to access hearing aids and assessments and reach out for queries.
Authority to release information form - client representatives
For client representatives – complete this form to provide us with permission to obtain information and documents from your client’s medical practitioners, employer, government agencies and other relevant parties regarding their claim, their health and their employment details.
Care Online access request
For attendant care providers – Use this form to request access to the Care Online electronic payment system.
Certificate of Capacity form
The Certificate of Capacity Form allows medical professionals to assess clients' work capabilities. Access the form and submit for claim support.
Common Law Time limit protocols
Review the Common Law Time Limit Protocols to ensure timely claims. Understand the procedures and file within the limits. Contact TAC for clarification.
Community access and transport assessment recommendations
Submit the Community Access and Transport Assessment form to gain transportation support. Check eligibility and get start or contact us for more details.
Community Access Plan: Initial plan and request for funding form (for Provider use only)
Providers can submit the initial Community Access Plan and request funding. Complete the form or reach out to TAC for further assistance about the plan.
Community Access Plan: Progress and/or outcome report form (for Provider use only)
Report on the progress of Community Access Plans with this form. Keep TAC informed and stay on track. Get in touch for more support.
Community discharge assessment form
Complete the Community Discharge Assessment form for post-hospital support services. Submit for review and assistance. Contact TAC for guidance.
Continence equipment prescription and order form: Community form (for provider use only)
Use this form to request continence equipment for community use. Submit to receive necessary items. Contact TAC for further assistance.
Continence equipment prescription and order form: Hospital discharge
Complete this form to receive continence equipment upon hospital discharge. Get the form and submit your request today. Reach out to TAC for more help.
Dental: dental report form
Access the Dental Report form for assessment and treatment recommendations. Complete and submit for your dental claims. Contact TAC for assistance.
Dental: maxillo facial report form
The Maxillo Facial Dental Report form helps with treatment recommendations. Submit for coverage of necessary services. Contact TAC for more info.
Education support: individual education plan
Submit the Individual Education Plan for educational support services. Get the necessary form and apply for assistance. Contact TAC to get started.
Education support services: Application for aide, teacher or tutoring request form
Complete the Education Support Services application for aide, teacher, or tutoring requests. Access resources for educational assistance. Contact us.
Epworth Hospital Transitional Living Centre - Request for admission extension form
Request an extension for admission at the Epworth Hospital Transitional Living Centre. Submit for continued rehabilitation services and contact for details.
Epworth Hospital Transitional Living Centre - Request for admission form
Submit the request for admission to the Epworth Hospital Transitional Living Centre for rehabilitative care. Get the form and submit today.
Equipment prescription form
Fill the Equipment Prescription Form to request necessary medical equipment. Complete the form and access essential items. Get in touch for support.
Exit Report (for Assertive Outreach or Case Management)
Provide an exit report for outreach or case management services. Ensure smooth transitions with detailed documentation. Contact TAC for assistance.
Funeral and Dependency Benefits claim form
Submit the Burial/Cremation and Dependency Benefits Claim Form to access funeral and dependency support. Start your claim with TAC today.
Group Formats
Gym and Pool Membership Request and Evaluation Form (for Provider use only)
Complete the Gym/Swim Program evaluation form for provider use. Submit your feedback to enhance participant experience. Contact TAC for details.
Holiday support plan
Request a Holiday Support Plan to assist with vacation or travel needs. Submit the form for customized assistance. Contact TAC to learn more.
Home modifications assessment and recommendations
Complete the Home Modifications Assessment for tailored recommendations on home adaptations. Submit to start the process. Contact TAC for details.
Home services assessment and plan
Submit the Home Services Assessment form for a personalized service plan. Start the process to receive home support. Reach out to TAC for further help.
Home services review
Review the Home Services provided to ensure your needs are met. Complete the review form for continued support. Contact TAC for guidance.
Hospital direct equipment order form
Order hospital equipment directly with the Hospital Direct Equipment Order form. Submit to receive the necessary items. Contact TAC for more information.
Initial needs assessment for (Assertive Outreach or Case Management)
For Assertive Outreach or Case Management – complete this form to provide an initial assessment of a client's support needs and goals for an assertive outreach or case management referral.
Initial occupational therapy assessment
Complete the Initial Occupational Therapy Assessment to determine rehabilitation needs. Submit for assessment approval. Contact TAC for any support.
Integration support: aide account form
Submit the Aide Account Form to access integration support services. Fill the form to receive the necessary assistance. Contact TAC for further queries.
Integration support: goal development worksheet
Use the Goal Development Worksheet to set objectives for integration support services. Submit for tailored assistance. Contact TAC for more information.
Integration support: teacher account form
Fill out the Teacher Account Form to access integration support for educational professionals. Get started today or reach out to TAC for further assistance.
Legal forms
TAC Protocols forms for legal providers. Includes JME request, JME reschedule, Impairment application, Serious Injury application, Dispute application and JME supplementary report request forms.
Living in the community assessment form
Complete the Living in the Community Assessment to evaluate rehabilitation and support needs. Submit for personalized care. Contact TAC for help.
Medical and pharmacy questionnaire
Submit the Medical and Pharmacy Questionnaire for accurate treatment and pharmacy assessments. Contact TAC for more details regarding the plan.
Medicinal Cannabis for Chronic Non Cancer Pain (CNCP) request form
Submit the request form for Medicinal Cannabis to treat chronic non-cancer pain. Get started and submit for approval. Contact TAC for assistance.
Mental health (social work, psychology and neuropsychology): treatment plan
Complete the Mental Health Treatment Plan for psychology and neuropsychology services. Submit for care options. Reach out to TAC for further support.
Network Pain Management Program: Comprehensive Report and Ongoing Management Plan
Submit the Comprehensive Report and Management Plan for the Network Pain Management Program. Get your report today. Contact TAC for support.
Network Pain Management Program: Follow Up Report and Plan
Provide a follow-up report for the Network Pain Management Program. Complete the form and ensure ongoing care. Contact TAC for support and queries.
Network Pain Management Program: Non-Completion of Program Report
Submit the Non-Completion of Program Report for the Network Pain Management Program and ensure accurate documentation. Contact us for details.
Occupational therapy review of capabilities
Complete the Occupational Therapy Review to assess functional capabilities. Submit for an updated assessment. Get in touch with TAC for further help.
Occupational therapy service plan review
Review and update the Occupational Therapy Service Plan for ongoing care. Submit the review form for adjustments. Contact TAC for more information.
Occupational therapy supported accommodation review of capabilities
Assess the need for supported accommodation through the Occupational Therapy Review. Submit for tailored recommendations. Contact TAC for support.
Opioid Safety and Management
Review and complete the Opioid Safety and Management plan for effective pain control. Submit the form for ongoing support. Contact TAC for guidance.
Orthotics device request form
Complete the Orthotics Device Request form for tailored support and device access. Submit for processing today. Connect with TAC for further assistance.
Outpatient Rehabilitation plan form
Submit the Outpatient Rehabilitation Plan form to access rehabilitation services. Get the plan in place for ongoing recovery. Contact TAC for more details.
Pain management service: inpatient multidisciplinary assessment form
Complete the Inpatient Multidisciplinary Assessment form for pain management services. Submit for review and approval. Reach out to TAC for assistance.
Pain management service: outpatient multidisciplinary assessment form
Submit the Outpatient Multidisciplinary Assessment form for pain management services. Get your treatment plan in place. Contact TAC for support.
Pharmacy: erectile dysfunction questionnaire
Complete the Erectile Dysfunction Questionnaire for accurate treatment recommendations. Submit today for assistance. Contact TAC for more details.
Position Formats
Progress Report (for Assertive Outreach or Case Management)
Use the Progress Report form for outreach and case management services. Submit to keep your case up to date. Get in touch with TAC for guidance.
Prosthetics: management review lower extremity form
Submit the Prosthetics Management Review form for lower extremities. Access tailored prosthetic solutions. Get in touch with TAC for further support.
Prosthetics: management review upper extremity form
Complete the Prosthetics Management Review for upper extremities. Submit for tailored care and solutions. Contact TAC for assistance.
Prosthetics: treatment request form
Submit the Prosthetics Treatment Request form for comprehensive care solutions. Get started and receive the necessary support. Contact us for clarity.
Provider Online Services registration application form
This form can be used by health services to request access the Provider Online Services (POS). This is a secure internet portal owned and operated by the Transport Accident Commission (TAC) and WorkSafe Victoria. POS enables you to check a patient's TAC / WorkSafe Victoria claim status. Please send your completed form to hdsg_admin@tac.vic.gov.au.
Provider registration
Register as a provider with TAC to receive funding and services. Complete the required form for seamless registration. Reach out for more details.
Rehabilitation at home discharge form
Check out the Rehabilitation at Home Discharge form for post-care services. Submit for ongoing home-based recovery. Contact TAC for support.
Rehabilitation at home extension request
Request an extension for rehabilitation at home services. Complete the extension request form for continued care. Contact TAC for assistance.
Rehabilitation at home initial assessment
Submit the Rehabilitation at Home Initial Assessment to start home-based rehabilitation. Get started with your assessment. Contact TAC for support.
Release of information solicitors forms
Complete the Release of Information Solicitors form for client data access and submit to begin the processing. Contact TAC for more details.
Repetitive transcranial magnetic stimulation request
Submit the request for Repetitive Transcranial Magnetic Stimulation for therapeutic treatment. Get started with your request. Contact TAC for support.
Restrictive Practice Providers
This is the list of the 39 Disability Service Providers who are in scope for Phase 1 of the Restrictive Practices Policy (to be implemented in April 2025)
Return to work: plan form
Create your Return to Work Plan with this form and ensure successful re-entry into the workplace. Contact TAC for assistance.
Ride-on mower assessment and recommendations
Occupational therapists – complete this form for all requests for ride-on-mowers and like vehicles (e.g. side-by-side and farm utility vehicles) and related equipment (e.g. tow-behind weed sprayers and trailers) for a TAC client.
Sedative Management Plan (SMP) form
Submit the TAC Sedative Management Plan form. Access the TAC Shared Supported Accommodation Property Enrolment Application for enhanced care options.
Serious incident and restrictive practice
Shared Supported Accommodation Property Enrolment Application
Complete the TAC Shared Supported Accommodation Property Enrolment Application. Learn about TAC Protocols Tabs for seamless provider support.
Shared Supported Accommodation Provider Registration
Register for TAC Shared Supported Accommodation Provider and explore TAC Telehealth Resources for enhanced care and support options.
Sleep Disordered Breathing & CPAP Questionnaire
Complete the TAC Sleep Disordered Breathing & CPAP Questionnaire. Ensure your clients receive the right support for their sleep health needs.
Special education: Assessment and recommendations form
Submit the TAC Special Education Assessment and Recommendations form. Learn how TAC can support your client’s ongoing educational needs.
Special education: Review and request ongoing services form
Submit the TAC Special Education Review form and request ongoing services. Learn about TAC's Speech Pathology Policy for better client support.
Speech pathology: management review plan (SPMR) form
Submit the TAC Speech Pathology Management Review Plan (SPMR) form. Discover how TAC's Support at Home can assist with your clients' ongoing care needs.
Speech pathology: treatment notification plan (SPTNP) form
Submit the TAC Speech Pathology Treatment Notification Plan (SPTNP) form. Learn about TAC's Support at Home Policy for tailored recovery assistance.
Surgery request form
Submit the TAC Surgery Request Form for approvals. Learn about TAC's Questionnaire Fees to ensure accurate billing and support throughout the process.
TAC freedom of information (FOI) application form - represented client
Complete the TAC Freedom of Information (FOI) Application Form for represented clients. Learn about TAC’s support for unlicensed drivers and services available.
Transition allied health and support plan
Access the TAC Transition Allied Health and Support Plan form. Learn about TAC’s travel and accommodation support to assist with your clients' recovery.
Travel expenses: declaration for carers (for Provider use only)
Submit the TAC Travel Form for provider use and update your provider contact details easily. Keep your information current for seamless support.
Tutoring support form
Complete the TAC Tutoring Support Form for education help. Access the TAC Urgent Psychiatric Admission Request for Funding Form for urgent care needs.
Type Formats
Update provider bank details
Revise your TAC provider bank details quickly. Complete this form to update your bank account details with us so your payments can be transferred to your new account.
Complete online – Update provider bank details
Update provider contact details
Update your TAC provider contact details quickly.
Urgent psychiatric admission: Request for funding form
Fill out the Urgent Psychiatric Admission Request form for immediate care. Ensure funding for psychiatric services. Reach out to TAC for assistance.
Vehicle modifications assessment and recommendations
Access TAC's Vehicle Modifications Assessment and Recommendations form. Learn what TAC covers and what we cannot pay for in your recovery journey.
Vocational Rehabilitation Suspension Report
Access the TAC Vocational Rehabilitation Suspension Report and understand the process. Use this form when vocational assistance to our clients needs to be suspended.
