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Government Issued ID
Please upload your Government Issued ID
In order to provide you with a prescription for medication or any other health service, we need to verify your identity. Since you do not have a Medicare card, we kindly ask that you provide us with your personal information and upload your ID. If you have any questions about the verification process, please feel free to contact us at 1300 858 909.
Name
(Required)
First
Last
The name of the person requesting the health service.
Date of Birth
(Required)
DD slash MM slash YYYY
The date of birth of the person requesting the health service.
Email
(Required)
Use the same email you used when requesting the health service.
Upload Image of Government Issued ID (eg. Drivers Licence, Passport, Proof of Age Card or Birth Certificate. Needs to clearly show your full name and date of birth.
(Required)
Drop files here or
Select files
Accepted file types: jpg, gif, png, jpeg, bmp, Max. file size: 15 MB, Max. files: 3.
Upload a copy of your government-issued ID such as an Australian Drivers license, Passport, Proof of Age Card, or Birth Certificate. We need to clearly sight the name and date of birth of the person requesting the health service.
Consent
(Required)
I understand and agree that by submitting this form, I am giving Medmate permission to collect and use the information provided for the purpose of verifying identity. I also understand that my information will not be shared with third-party services. I have read and agree to the Medmate
privacy policy
, which describes how my information will be used and protected.
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.