Health Care Facility New Licence Application

About this form

This form is to be used to apply for a health care facility activity licence under the ACT Health Care Facilities Code of Practice 2001, an enforceable Code of Practice under the Public Health Act 1997.

Health care facilities are premises where prescribed medical and dental procedures are carried out and/or premises in which overnight patient stays are provided prior to or after receiving medical treatment.

Attachments

  • One form of current photographic identification of each signatory must be provided, sighted and certified by an authorised witness. For details please see Identification requirements.
  • For Company applications a copy of the company’s current extract (issued within the previous 30 days) from the Australian Securities and Investment Commission (ASIC). This can be obtained on the ASIC website.
  • A floor plan showing the layout of all fixtures and fittings of the premises must accompany this application.

Fees

Type of facility Annual fee
Accredited facility (<200 beds) $623
Accredited facility (>200 beds) $1245
Non-accredited facility $932
Sole dental practitioner $249

More information

For more information, see Health care facilities licensing.

Payment options

Visa and MasterCard logos

Payments up to $10,000 can be made with either Visa or MasterCard.

Your personal information

Access Canberra uses this form to collect information which is necessary to allow the ACT Government to provide services to you. Personal Information may be used or disclosed in accordance with the Information Privacy Act 2014.

For details on the collection of personal information in this form please refer to the Access Canberra Information Collection Notice. If you have questions about how your information will be handled please see the Access Canberra Privacy Policy and the ACT Health Privacy Notice or contact us.