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Downloadable Forms

Membership Application Form

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Request to change membership, contact details or card request Form

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Referral Letter Form

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Specialist feedback Form

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Chronic Medication Delivery Order Form

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PlatComprehensive Chronic Illness Benefit Application Form

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Maternity Visits Specialist Feedback Form

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HIV Management Programme Application Form

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Platinum Health Supplier Information Form

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Group Practice Information Form

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PlatCap Chronic Illness Benefit Application Form

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PlatFreedom Chronic Illness Benefit Application Form

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Maternity Programme Registration PlatCap

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Maternity Programme Registration PlatComprehensive

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Maternity Programme Registration PlatFreedom

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Debit Order Instruction Form

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Radiology Authorisation Request Form

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EX GRATIA APPLICATION FORM

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Membership Continuation Form

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Confirmation of Medical Form

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