NHI Lookup Service Application Form

This application form should not be used for new HealthLink EDI accounts.  Please use the link here if you need an EDI account.

Please complete the application form below. (Required fields marked with *)

NHI Lookup *  (The cost of NHI Lookup is included in your HealthLink account. If you do not have a HealthLink account you will be charged $15 per month to use this service.)
        NHI Lookup is compatible with Internet Explorer for Windows users and Firefox for Mac users
Practice/Organisation Name *
Practice/Org. Street Address *
Suburb
City *
Post Code *
Postal Address
Only complete postal address if
different to street address
Suburb
City
Post Code
Practice/Org. Telephone *    e.g. 09 1234567
Practice/Org. Fax *
Practice/Org. Email
Applicants Name (Unless requested in the comments field, application packs will be posted to the applicant below)
First Name*
Last Name*

Additional Comments

Service Agreement *

NOTE: After submission of your application, a comprehensive NHI application pack will be posted to the person you indicate on the application form above. This application needs to be completed in full and posted back to HealthLink. Please note that the process of approval may take 6 weeks or longer. You will be notified by HealthLink once the NHI Access has been implemented for your practice.

Full Name
Position

I hereby apply on behalf of the afore mentioned practice / organisation to use the services offered by HealthLink Ltd and agree to comply with all terms and conditions set out in the Healthlink Service Agreement including all schedules published at www.healthlink.net.  Can't view the Service Agreement? Click here to download the Adobe Reader