Medisecure

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All MediSecure® original e-prescriptions and resulting repeats qualify for the government 15c incentive per script as per the 5th Agreement starting 1 July 2010.

Sign up now to qualify for the incentive!

Doctors,
Join MediSecure® to promote better health outcomes for your patients.

There are no fees for you to become involved in MediSecure® - simply fill out the form below and we will get you connected.

Mandatory fields indicated by *

Personal Details

First Name

*

Last Name

*

Position

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Practice Name

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Company Name (if different to Practice Name)

ABN

Format: dd ddd ddd ddd

Clinical System

*

Clinical Messaging System(s)

Multiple Selection: Hold the "Ctrl" key as you select.
Mac Users: Hold the "Command" key as you select.

*

Medical Group Name

Phone number

*

E-Mail Address

*

Practice Website

Practice Address

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Practice Suburb

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Practice State

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Practice Post Code

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Postal Address as above

Postal Address

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Postal Suburb

*

Postal State

*

Postal Post Code

*

Name and prescriber # of each doctor practising from this location

First Name	Last Name	Prescriber #

Additional Information

I wish to join MediSecure® and I have read and agreed to the terms and conditions. *
I have the authority to enter this Agreement on behalf of this practice. *