Health and service provider registration form

Start Navigation [Current Level] End Navigation [Current Level]

To register as a TAC health or service provider, please complete the form below.

If you are a disability service provider, please visit our disability services registration page.

Provider details

if payable to the company

Service Location

Postal Address

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 *