HealthLink Service Registration Page

HealthLink Service Application Form

Please complete this form to register for a HealthLink Client or Portal Account.
(For updates to your account information, please email [email protected])

Upon receipt of your application, you may be called to verify your practice details, or the details of your providers by a HealthLink Registration Team member.

You will be notified by HealthLink once your application is approved. The process of approval may take three working days.

HealthLink’s Terms and Conditions of Use

In order to be provided with either a HealthLink Client (on premise) or HealthLink Portal (cloud) account you must agree to abide by the HealthLink Terms of Use and Master Service Agreement.

The Terms of Use can be found here.

Your organisation details

COMPANY NAME*

TRADING NAME (IF DIFFERENT FROM ABOVE)

ABN

STREET ADDRESS*

SUBURB*

POST CODE*

POSTAL ADDRESS (IF DIFFERENT FROM ABOVE)

SUBURB

POST CODE

HEALTH PROVIDER IDENTIFIER ORGANISATION NUMBER (HPI-O)

PHONE*

FAX (please leave blank if you do not have a fax number)

ORGANISATION EMAIL ADDRESS*

ORGANISATION TYPE*

CLINICAL OR REPORTING SOFTWARE USED*

OPERATING SYSTEM OF HOST WHERE HEALTHLINK WILL BE INSTALLED*

WHAT WOULD YOU LIKE TO USE HEALTHLINK FOR?*
Receive Electronic Correspondence (Free of charge)Send Electronic Correspondence (This may incur a charge)Send Electronic Smart Forms (My Aged Care, Transport for NSW, Monash Health etc)
DO YOU AGREE TO ABIDE BY THE HEALTHLINK TERMS AND CONDITIONS OF USE?*
I agree on behalf of the Applicant that the Applicant will abide by the HealthLink Terms of Use and Master Service Agreement
AUTHORISED REPRESENTATIVE NAME*

AUTHORISED REPRESENTATIVE PHONE*

AUTHORISED REPRESENTATIVE EMAIL*

AUTHORISED REPRESENTATIVE COMPANY POSITION OR TITLE*

COMMENTS OR ADDITIONAL INFORMATION

HOW MANY PROVIDERS DO YOU WISH TO REGISTER WITH YOUR ACCOUNT?* (If more than 9, please add additional in the comments section or email list to [email protected])