Provider Registration

Provider Registration
Provider Registration

This form is used by Doctors to register for participation in Access Gap Cover. Only the Doctor can sign on the form. It is essential that you register the associated Provider Number you are using when submitting claims. You can also use this generic form to update changes to the email, contact, postal and/or banking information. It is very important to make sure you complete all sections of the relevant form. The Doctor is required to sign the Provider Details form.