Medicare Bulk Bill Authorisation

Assignment of Medicare Benefits for Bulk Billing

By completing this form you are authorising TFD Services to process a bulk bill transaction through Medicare for the service you received and assign the benefit to the treating psychologist.

Appointment Item number : 91170 – 50+ minute focused psychological session

Provider: Sara McCartney 4031024Y

Medicare Bulk Bill Authority

Name(Required)
Date of Appointment(Required)
Signature(Required)

TFD Services collects and handles your personal information in accordance with the Privacy Act 1988, for the purpose of assessing entitlement to, and administration of, payments and services.

This information has been collected to enable us to process your claim. Failure to provide this information may prevent you from accessing bulk billing.

Your personal information may be used by us or disclosed to other parties for the purposes of research, investigation or where you have agreed, or if required or authorised by law.

You can read our Privacy Policy contained within the Statement of Provision of Service, which includes information about:

  • how we handle your personal information,
  • accessing or requesting a change to your personal information,
  • how you can make a complaint if you think your privacy has been breached.