Apply for Priority Assistance

All fields are mandatory unless marked as optional.

Before you start

Welcome, let us fill in some of your details

Because you've already signed in with your Telstra ID, when you open the form, we'll populate parts of the form so you can submit it faster.

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  • You'll need to provide medical certification from a doctor that includes the doctor's:
    • name
    • phone and address details
    • provider number
    • signature.  
  • The medical certificate should:
    • state the patient's name and 
    • certify that they suffer from a diagnosed life-threatening medical condition with a high risk of rapid deterioration to a life-threatening situation where access to a telephone would assist to remedy the life-threatening situation.
    • not include details of the specific medical condition or any medication lists.
  • We accept statutory declarations if the patient is having trouble getting to see a medical practitioner.

Sign in to complete the form faster

If you're a Telstra customer, you can choose to sign in with your Telstra ID, we'll already have some of your details, so you can submit the form faster. If you haven't already created a Telstra ID you can do this in just a few steps. Tell us what you'd like to do.

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Customer details

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Please enter date in dd/mm/yyyy
This will be the home phone number we'll set up for Priority Assistance. Include your area code e.g. 03

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Select from the options below or enter another email address

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Representative details

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This must be an Australian mobile or home phone number

Required field. Invalid entry. Contact number must be at least 6 digits.

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Medical condition

How would a doctor classify the patient’s medical condition? Required field. Required field.

Medical certificate

File up to 4MB. Examples of acceptable files are .png, .gif, .jpg, .tif, .pdf, .doc, .docx

Please upload a medical certificate

Privacy statement

Note that the information provided by you in this form, except information relating to your/the patient's medical condition is collected by Telstra, in the ordinary course of providing the services you require. Details about the privacy protections Telstra gives to your personal information, which Telstra collects in the ordinary course, are set out in Telstra's Privacy Statement. That statement will also be provided to new customers before or shortly after acquiring the services from Telstra.

Privacy statement for patients

"Patient" refers to the individual who has the diagnosed life-threatening medical condition. The information provided on this form relating to the patient’s medical condition is collected by Telstra for the purpose of assessing the customer’s eligibility for Priority Assistance and for providing Telstra services to the customer, including Priority Assistance.

Telstra does not ordinarily disclose information relating to the customer/patient's medical condition to third parties unless disclosure of that information is necessary in delivering a service to you or is otherwise authorised or required by law. You can read more about our privacy policy in Telstra's Privacy Statement. If the information relating to the patient’s medical condition (as set out in this form) is not provided to Telstra, Telstra will not be able to provide Priority Assistance.

Except in certain cases, the patient may gain access to personal information about him or herself, which is held by Telstra, by contacting 1300 112 376. There may be a cost (which will not be excessive) associated with such access.

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