ANAESTHETIC & MEDICAL BILLING SERVICES: REGISTRATION

Doctor Registration Form

Anaesthetic and Medical Billing Services

Suite 508, 89 High Street (PO Box 540), Kew, VIC 3101
Telephone: (03) 9855 2149 | Fax: (03) 8677 6907

Doctor's Medicare Provider Numbers

Provider No

Hospital

Provider No

Hospital

Provider No

Hospital

Provider No

Hospital

Provider No

Hospital

Provider No

Hospital

Provider No

Hospital

Provider No

Hospital

Provider No

Hospital

Provider No

Hospital

Doctor's Details

Doctor’s Full Name * Text value required

Qualifications

Specialty

Address

Phone

Fax

Mobile

ABN number

Bank Details:

Name of Bank

Branch

Account Name

BSB

Account No.

Please indicate how you would like the Health Fund Registrations done: * Please select one option

Please indicate how you would like to be charged for your accounts: * There is a minimum fee of $8.00 plus GST per account. Please select one option

How did you hear about us?

By submitting this form, I accept that the information entered will be used within the strict framework of my request* Checkbox mandatory

*These fields are mandatory

Anaesthetic & Medical Billing Services is committed to ensuring that the collection and processing of data carried out by our ambs.net.au site complies with the General Data Protection Regulations (GDPR) and the Data Protection Act. To know and exercise your rights, particularly concerning the withdrawal of consent to the use of collected data, please consult our privacy policy

DISCLAIMER: It is the responsibility of the doctor to ensure his provider number is registered and he is able to claim for the services provided. It is also the responsibility of the doctor to inform patients of costs and get patients to sign consent forms unless otherwise arranged with AMBS. AMBS will not charge a commission until they get payment of an account unless the account is not claimable or the doctor decides to write the account off before AMBS have finished chasing it up.