Health and service provider registration form

To register as a TAC health or service provider, please check our registration requirements, then complete the form below. If you are a disability service provider, please visit our disability services registration page.

If you have already registered as a TAC provider and need to update your bank details, please use our Update provider bank details form.

Provider details
Is this updating a business that is already registered with TAC ? eg business is purchased/sold, new trading name, new ABN etc
(if payable to the company)
(Please upload any information relevant to your registration, certificates etc if required )
Service Location
Service Postcode
Postal Address
Postal Address
Postal Suburb/City
Postal State
Postal Postcode
Bank account details
(no spaces)
(no spaces)

Your privacy

The TAC will use this information in accordance with the Privacy and Data Protection Act 2014. We will use this information to register you as a TAC provider for the first time. We will use your bank account details to make EFT payments to you. We may use this information to contact you, provide general TAC news and information and for reasonable secondary purposes.

For more information, please see our Privacy policy.

Disclaimer *